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Master thesis

Thrombolyse de l’infarctus cérébral par télémédecine comparée au traitement directement instauré dans une unité neurovasculaire expérimentée Thrombolyse de l’infarctus cérébral : Télémédecine versus unité neurovasculaire

Abstract : Background : Telemedicine is emerging as a reliable tool for examining and delivering treatment to patients during the acute phase of stroke but little is known about patient outcome in this setting. We retrospectively compared time to diagnosis and outcomes of patients assessed via a telestroke system (Virtuall, established in Lorrain, east France) with those treated by experienced staff in a stroke unit.Methods : We compared time to examination and outcomes between two groups of consecutive patients treated with intravenous of recombinant tissue plasminogen activator (rt-PA) at the acute phase of ischemic stroke between 1st July 2013 and 31st June 2014. One group of patients was managed via the telestroke system and the second at the bedside in the stroke unit of Nancy Hospital. Examination and treatment decisions were performed by the same physicians in both groups.Results : During this period 27 patients received rt-PA via the telestroke system and 70 in the stroke unit. Both groups were similar in terms of age (75 ± 15 vs. 74 ± 12 years, p = 0.36) and severity of stroke (initial National Institutes of Health Stroke Scale score at 12 ± 9 vs. 14 ± 10, p = 0.68). There was no significant difference in onset to needle times (188 ± 64 vs. 178 ± 60 minutes, p = 0.35), despite a longer door to needle time in the telestroke system group (91 ± 45 vs. 56 ± 20 minutes, p < 0.001). Outcome was similar in both groups : intracranial haemorrhage (19 vs. 24 %, p = 0.60); death (30 vs. 20 %, p = 0.42); and patient independence at 3 months (modified Rankin Scale score ? 1: 30 vs. 31 %, p = 1.00).Conclusion : This study demonstrates that the telestroke system, Virtuall, is as safe and effective in initiating rt-PA treatment as bedside evaluation in an experienced stroke unit, despite a longer intra-hospital time. This system can be considered as one of the leading treatment of ischemic stroke
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https://hal.univ-lorraine.fr/hal-01734115
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Lucile Raulot. Thrombolyse de l’infarctus cérébral par télémédecine comparée au traitement directement instauré dans une unité neurovasculaire expérimentée Thrombolyse de l’infarctus cérébral : Télémédecine versus unité neurovasculaire. Sciences du Vivant [q-bio]. 2015. ⟨hal-01734115⟩

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