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. 2024 Nov 27;24(1):224.
doi: 10.1186/s12873-024-01142-3.

Prehospital telemedicine support for urban stroke care: Analysis of current state of care and conceptualization

Daniel Weiss  1 , Christian Rubbert  1 , Marius Kaschner  1 , Gregory Gordon Greiner  2   3 , Nadja Kairies-Schwarz  2 , Markus Vomhof  2   3 , Andrea Icks  2   3 , Linea Weitz  1 , Hanna Hollenberg  4 , Robin Jansen  4 , Til Menge  5 , Rüdiger J Seitz  5 , Sebastian Jander  6 , Michael Bernhard  7 , John-Ih Lee  4 , Tobias Ruck  4 , Sven Guenther Meuth  4 , Bernd Turowski  1 , Julian Caspers  1 , Michael Gliem  8
Affiliations

Prehospital telemedicine support for urban stroke care: Analysis of current state of care and conceptualization

Daniel Weiss et al. BMC Emerg Med. .

Abstract

Background: The reduction of processing times in the treatment of acute ischemic stroke is of outstanding importance. Our objective is to analyze the acute stroke care chain from onset to treatment in a city in Germany comprising three stroke units. Additionally, we discuss solutions for detected treatment delays.

Methods: We conducted an in-depth analysis of acute stroke care processing times across three local stroke centers in Düsseldorf among all emergency services transportations for suspected stroke. Isochrone mapping was performed to identify areas with prolonged transportation times.

Results: Among the 1,714 transportations, 943 patients had confirmed strokes. Prehospital care constituted 58% of total emergency care time until imaging. Patients with confirmed stroke had reduced in-hospital times while patients receiving treatment experienced faster in-hospital times. Isochrone mapping revealed disparities in transportation times within the city.

Conclusions: In conclusion, we identified confirmation of stroke symptoms as pre- and in-hospital and treatment eligibility as in-hospital process accelerators in stroke care. We propose the introduction of an in-ambulance video consulting model to accelerate contact to stroke-experts and accelerate processing times for patients eligible for treatment. Furthermore, we discuss the combination of in-ambulance video consulting with imaging and starting treatment outside traditional stroke centers, followed by transportation to a stroke center during thrombolysis, which might further accelerate treatment in specific cases.

Keywords: Cost efficiency; Models of care; Outcome; Stroke.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Both the approval of the study and the waiver of written informed consent were granted by the Ethics Committee of the Faculty of Medicine of the Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf (ID: 2021–1494). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow-chart of case inclusion. EMS = emergency medical services; TIA = transient ischemic attack; CT = computed tomography; MRI = magnetic-resonance-tomography
Fig. 2
Fig. 2
Timeline from alarm-to-imaging-time for a) all suspected stroke cases (n = 860) and b) treated patients (n = 121). A = alarm-time, B = pickup-time, C = door-time, D = imaging-time, E = needle-time, F = groin-puncture-time. The numbers in the bars correspond to the means and standard deviations of the time periods in minutes
Fig. 3
Fig. 3
Therapy related times for patients who underwent endovascular treatment for patients with complete datasets from image to groin puncture. MS = mothership principle (n = 39), DnD = drip-and-drive principle (n = 26), DnS = drip-and-ship principle (n = 20), black bar = imaging-time, F = groin-puncture-time, X = arrival-time. The numbers in the bars correspond to the means and standard deviations of the time periods in minutes
Fig. 4
Fig. 4
Isochrone maps for transport times for all stroke units. A comprehensive stroke center (yellow); B (blue), C (green) = primary stroke centers, a-d = general hospitals; numbers indicate the time benefit of transporting patients to the nearest CT (a-e) rather than the Stroke Unit in minutes
See this image and copyright information in PMC

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