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Rural Victorian Telestroke project
Author(s) -
Nagao K. J.,
Koschel A.,
Haines H. M.,
Bolitho L. E.,
Yan B.
Publication year - 2012
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2011.02603.x
Subject(s) - medicine , thrombolysis , stroke (engine) , intracerebral hemorrhage , acute stroke , emergency medicine , incidence (geometry) , intervention (counseling) , economic shortage , surgery , tissue plasminogen activator , glasgow coma scale , myocardial infarction , physics , optics , psychiatry , mechanical engineering , engineering , linguistics , philosophy , government (linguistics)
Background Intravenous thrombolysis improves functional outcomes in acute ischaemic stroke. However, many rural stroke patients are denied thrombolysis because of a rural neurologist shortage. ‘ T elestroke’ facilitates thrombolysis by providing remote access to neurologists via videoconferencing systems. Aims To develop a safe and feasible T elestroke system in a rural V ictorian hospital that facilitates delivery of intravenous thrombolysis to acute ischaemic stroke patients. Methods A pilot videoconferencing T elestroke system was set up between R oyal M elbourne H ospital and N ortheast H ealth W angaratta. Acute stroke patients presenting within 4.5 h of symptom onset without intracranial haemorrhage were eligible for Telestroke. However, eligible patients were excluded from Telestroke if they had haemorrhagic risk factors. Data were collected from intervention ( O ctober 2009– S eptember 2010) and control group ( O ctober 2008– S eptember 2009) by medical file audit. Primary outcome measure was percentage of patients thrombolysed. Secondary outcome measures included incidence of symptomatic intracerebral haemorrhage and door‐to‐computed tomography time. Results One hundred and forty‐five acute stroke patients presented in control year and 130 patients in intervention year. Fifty‐four patients in intervention and 36 patients in control group were eligible for thrombolysis. In intervention group, 24 patients had T elestroke activated and 8 patients underwent thrombolysis. There was no thrombolysis in the control group. There were neither symptomatic intracerebral haemorrhages nor deaths attributable to thrombolysis. Median door‐to‐computed tomography time did not significantly differ between eligible patients in control and intervention groups. Conclusion T elestroke has the potential to bridge the gap of rural–metropolitan inequality in acute stroke care. Our T elestroke system successfully introduced safe thrombolysis and early specialist review of acute stroke patients in rural V ictoria.