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Telemedicine for the acute management of stroke in Burgundy, France: an evaluation of effectiveness and safety
Author(s) -
Legris N.,
HervieuBègue M.,
Daubail B.,
Daumas A.,
Delpont B.,
Osseby G.V.,
Rouaud O.,
Giroud M.,
Béjot Y.
Publication year - 2016
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13054
Subject(s) - medicine , thrombolysis , odds ratio , modified rankin scale , confidence interval , context (archaeology) , logistic regression , telemedicine , case fatality rate , stroke (engine) , emergency medicine , odds , myocardial infarction , epidemiology , ischemic stroke , health care , mechanical engineering , paleontology , ischemia , engineering , economics , biology , economic growth
Background In the context of the development of telemedicine in France to address low thrombolysis rates and limited stroke infrastructures, a star‐shaped telestroke network was implemented in Burgundy (1.6 million inhabitants). We evaluated the safety and effectiveness of this network for thrombolysis in acute ischemic stroke patients. Methods One hundred and thirty‐two consecutive patients who received intravenous thrombolysis during a telemedicine procedure (2012–2014) and 222 consecutive patients who were treated at the stroke center of Dijon University Hospital, France (2011–2012) were included. Main outcomes were the modified Rankin scale ( mRS ) score and case fatality at 3 months. Comparisons between groups were made using multivariable ordinal logistic regression and logistic regression analyses, respectively. Results Baseline characteristics of telethrombolysis patients were similar to those of patients undergoing thrombolysis locally except for a higher frequency of previous cancer and pre‐morbid handicap, and a trend towards greater severity at admission in the former. The distribution of mRS scores at 3 months was similar between groups, as were case‐fatality rates (18.9% in the telethrombolysis group versus 16.5%, P = 0.56). In multivariable models, telethrombolysis did not independently influence functional outcomes at 3 months ( odds ratio for a shift towards a worse outcome on the mRS, 1.11; 95% confidence interval , 0.74–1.66, P = 0.62) or death ( odds ratio, 0.86; 95% confidence interval, 0.44–1.69, P = 0.66). Conclusion The implementation of a regional telemedicine network for the management of acute ischemic stroke appeared to be effective and safe. Thanks to this network, the proportion of patients who benefit from thrombolysis will increase. Further research is needed to evaluate economic benefits.