stroke organization

INTRODUCTION: Telestroke systems as known today used currently recommend imply transfer of patients with acute strokes to Community Hospitals (CommH) that cannot offer endovascular procedures (EVT). The primary benefit of this policy relies on the fact that intravenous ( tissue plasminogen activator (iv-tPA) one, may be offered earlier and two, unnecessary transfers to Comprehensive Stroke Centers (CSC) can be avoided. However, this strategy may generate time delays in potential EVT candidates. This study aimed to quantify the potential benefits and disadvantages of this strategy.

 METHODS: From March 2013 to March 2014, 533 teleconsults were centrally attended by stroke neurologists in the Catalan telestroke system that covers 105 CommH. We defined criteria to identify potential EVT candidates ion the f-field or in the CommH after teleconsultation (clinical and radiological).

 RESULTS: 
Eighty-four patients (15.7 %) could have been identified on-in the field before arrival to CommH as potential EVT candidates. Once at the CommH, of these 84 patients, 60 (71 %) were still potential EVT candidates after CT-scan and teleconsultation. Of these 84 patients, only 27 (32 %) received iv-TPA in the CommH; however 68 (80 %) were still emergently transferred to CSC, where only 13(19 %) finally received EVT. The median time from CommH-door to groin puncture was 216 min vVs CSC-door to groin 152 min for primary CSC admissions (p<0.01).
 CONCLUSIONS: 
Present telestroke systems offer safe and timely iv-tPA treatment to eligible patients but may induce a considerable time loss in EVT candidates. Only a third1/3 of the on-field potential EVT candidates benefit from admission in a CommH when being treated with iv-tPA, while more than three quarters 3/4 will still be transferred to the CSC.