Stroke Thrombolysis in a Centralized and a Decentralized System (Helsinki and Telemedical Project for Integrative Stroke Care Network).

Gordian J Hubert Atte Meretoja Heinrich J Audebert Turgut Tatlisumak Florian Zeman Sandra Boy Roman L Haberl Markku Kaste Peter Müller-Barna

Stroke

From the Department of Neurology, TEMPiS, Städtisches Klinikum München, Germany (G.J.H., R.L.H.); Department of Neurology, Helsinki University Central Hospital, Finland (A.M., T.T., M.K.); Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (A.M.); Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia (A.M.); Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (H.J.A.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); Center for Clinical Studies, University Hospital Regensburg, Germany (F.Z.); Department of Neurology, Asklepios Stadtklinik Bad Tölz, Germany (S.B.); and Department of Analysis, Concept and Consulting, Medical Services of Compulsory Health Insurance Funds, Munich, Germany (P.M.-B.).

Published: December 2016

The study compares a centralized hospital system in Helsinki, Finland, and a decentralized telemedicine network in South-East Bavaria, Germany, to assess the effectiveness of tPA treatment for acute ischemic stroke.
Both systems had similar rates of tPA treatments despite differing geographical challenges, with Helsinki's delays being longer in prehospital settings but shorter in-hospital than TEMPiS.
The findings suggest that decentralized telemedicine can achieve comparable treatment outcomes in rural areas, highlighting its potential as an effective approach for stroke care.

Background And Purpose: Intravenous thrombolysis with tissue-type plasminogen activator (tPA) for acute ischemic stroke is more effective when delivered early. Timely delivery is challenging particularly in rural areas with long distances. We compared delays and treatment rates of a large, decentralized telemedicine-based system and a well-organized, large, centralized single-hospital system.

Methods: We analyzed the centralized system of the Helsinki University Central Hospital (Helsinki and Province of Uusimaa, Finland, 1.56 million inhabitants, 9096 km) and the decentralized TeleStroke Unit network in a predominantly rural area (Telemedical Project for Integrative Stroke Care [TEMPiS], South-East Bavaria, Germany, 1.94 million inhabitants, 14 992 km). All consecutive tPA treatments were prospectively registered. We compared tPA rates per total ischemic stroke admissions in the Helsinki and TEMPiS catchment areas. For delay comparisons, we excluded patients with basilar artery occlusions, in-hospital strokes, and those being treated after 270 minutes.

Results: From January 1, 2011, to December 31, 2013, 912 patients received tPA in Helsinki University Central Hospital and 1779 in TEMPiS hospitals. Area-based tPA rates were equal (13.0% of 7017 ischemic strokes in the Helsinki University Central Hospital area versus 13.3% of 14 637 ischemic strokes in the TEMPiS area; P=0.078). Median prehospital delays were longer (88; interquartile range, 60-135 versus 65; 48-101 minutes; P<0.001) but in-hospital delays were shorter (18; interquartile range, 13-30 versus 39; 26-56 minutes; P<0.001) in Helsinki University Central Hospital compared with TEMPiS with no difference in overall delays (117; interquartile range, 81-168 versus 115; 87-155 minutes; P=0.45).

Conclusions: A decentralized telestroke thrombolysis service can achieve similar treatment rates and time delays for a rural population as a centralized system can achieve for an urban population.

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http://dx.doi.org/10.1161/STROKEAHA.116.014258	DOI Listing

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