Background: Telemedicine stroke networks are mandatory to provide inter-hospital transfer for mechanical thrombectomy (MT). However, studies on patient selection in daily practice are sparse.
Methods: Here, we analyzed consecutive patients from 01/2014 to 12/2018 within the supraregional stroke network "Neurovascular Network of Southwest Bavaria" (NEVAS) in terms of diagnoses after consultation, inter-hospital transfer and predictors for performing MT. Degree of disability was rated by the modified Rankin Scale (mRS), good outcome was defined as mRS ≤ 2. Successful reperfusion was assumed when the modified thrombolysis in cerebral infarction (mTICI) was 2b-3.
Results: Of 5722 telemedicine consultations, in 14.1% inter-hospital transfer was performed, mostly because of large vessel occlusion (LVO) stroke. A total of n = 350 patients with LVO were shipped via NEVAS to our center for MT. While n = 52 recanalized spontaneously, MT-treatment was performed in n = 178 patients. MT-treated patients had more severe strokes according to the median National institute of health stroke scale (NIHSS) (16 vs. 13, p < 0.001), were more often treated with intravenous thrombolysis (64.5% vs. 51.7%, p = 0.026) and arrived significantly earlier in our center (184.5 versus 228.0 min, p < 0.001). Good outcome (27.5% vs. 30.8%, p = 0.35) and mortality (32.6% versus 23.5%, p = 0.79) were comparable in MT-treated versus no-MT-treated patients. In patients with middle cerebral artery occlusion in the M1 segment or carotid artery occlusion good outcome was twice as often in the MT-group (21.8% vs. 12.8%, p = 0.184). Independent predictors for performing MT were higher NIHSS (OR 1.096), higher ASPECTS (OR 1.28), and earlier time window (OR 0.99).
Conclusion: Within a telemedicine network stroke care can successfully be organized as only a minority of patients has to be transferred. Our data provide clinical evidence that all MT-eligible patients should be shipped with the fastest transportation modality as possible.
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http://dx.doi.org/10.1007/s00415-020-10165-2 | DOI Listing |
Neurol Ther
December 2024
Department of Neurology, Yijishan Hospital, Wannan Medical College, 2# Zheshan West Road, Wuhu, 241001, Anhui, China.
Int J Artif Organs
December 2024
Department of cardiovascular surgery, TC Saglik Bakanligi Kosuyolu Yuksek Ihtisas Egitim ve Arastirma Hastanesi, Istanbul, Turkey.
Int J Stroke
November 2024
School of Cardiovascular & Metabolic Health, University of Glasgow Queen Elizabeth University Hospital, Glasgow G51 4TF, Scotland UK.
Recent clinical trials provide robust evidence of non-inferiority of tenecteplase 0.25mg/kg over alteplase 0.9mg/kg in acute ischaemic stroke treated within 4.
View Article and Find Full Text PDFObjective: To evaluate the relationship between center volume and inpatient mortality after inter-hospital transfer among patients undergoing pediatric cardiac surgery using contemporary real-world data.
Methods: The Kids' Inpatient Database (KID) was queried for cardiopulmonary bypass (CPB) cases (CPB) for years 2016 and 2019. Hospitals were divided into three groups based on terciles of volume: "low": ≤103 cases/year, "mid":104-194 cases/year, and "high": >194 cases/year.
Obstet Med
May 2024
Department of Obstetrics and Gynaecology, Rotunda Hospital, Ireland.
Background: Births in non-maternity hospitals pose significant challenges to ensure delivery of safe and effective care.
Methods: We conducted a retrospective chart review examining the maternal and neonatal demographics and care needs of women delivering in a non-obstetric general hospital over a 10-year period.
Results: Cardiac conditions and placenta accreta spectrum disorder were the most common reasons for birth in this location.
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