'Improves' IS NOT GOOD ENOUGH! You do realize survivors want 100% recovery? Or are you that incompetent you don't know what survivors want?
Telemedical stroke care significantly improves patient outcome in rural areas – long-term analysis of the German NEVAS network
Abstract
Background.
Comprehensive
stroke centers (CSC) offer state-of-the-art stroke care in metropolitan
centers. However, in rural areas sufficient stroke expertise is much
scarcer. Recently, telemedical stroke networks have offered instant
consultation by stroke experts, enabling immediate administration of
intravenous thrombolysis (IVT) on-site and decision on thrombectomy.
While these immediate decisions are made during the consult, the impact
of the network structures on stroke care in spoke hospitals is still not
well described.
Aims.
This
study was performed to determine if on-site performance in rural
hospitals and patient outcome improve over time through participation
and regular medical staff training within a telemedical stroke network.
Methods.
In
this retrospective study, we analyzed data from stroke patients treated
in four regional hospitals within the telemedical Neurovascular Network
of Southwest Bavaria (NEVAS) between 2014-2019. We only included those
patients that were treated in the regional hospitals until discharge at
home or to neurorehabilitation. Functional outcome (modified Rankin
scale) at discharge, mortality rate and periprocedural intracranial
hemorrhage served as primary outcome parameters. Door-to-imaging and
door-to-needle times were secondary outcome parameters.
Results.
In
2014-2019, 5,379 patients were treated for acute stroke with 477
receiving IVT. Most baseline characteristics were comparable over time.
For all stroke patients, door-to-imaging times increased over the years,
but significantly improved for potential IVT candidates and those
finally treated with IVT. The percentage of patients with door-to-needle
time <30 minutes increased from 10% to 25%. Clinical outcome at
discharge improved for all stroke patients treated in the regional
hospitals. Particularly for patients treated with IVT, good clinical
outcome (modified Rankin scale 0-2) at discharge increased from 2014 to
2019 by 19% and mortality rates dropped from 13% to 5%.
Conclusions.
24h/7d
telemedical support and regular on-site medical staff training within a
structured telemedicine stroke network such as NEVAS significantly
improve on-site stroke care(You need to measure results!) in rural areas, leading to a considerable
benefit in clinical outcome. Data access statement: The data that
support the findings of this study are available upon reasonable request
and in compliance with the local and international ethical guidelines.
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