Rural Victorian Telestroke project

摘要

Background: Intravenous thrombolysis improves functional outcomes in acute ischaemic stroke. However, many rural stroke patients are denied thrombolysis because of a rural neurologist shortage. 'Telestroke' facilitates thrombolysis by providing remote access to neurologists via videoconferencing systems. Aims: To develop a safe and feasible Telestroke system in a rural Victorian hospital that facilitates delivery of intravenous thrombolysis to acute ischaemic stroke patients. Methods: A pilot videoconferencing Telestroke system was set up between Royal Melbourne Hospital and Northeast Health Wangaratta. Acute stroke patients presenting within 4.5h 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 (October 2009-September 2010) and control group (October 2008-September 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 Telestroke 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: Telestroke has the potential to bridge the gap of rural-metropolitan inequality in acute stroke care. Our Telestroke system successfully introduced safe thrombolysis and early specialist review of acute stroke patients in rural Victoria.