London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 669 611 Acute stroke: emergency management, stroke units and complications Introducing Telemedicine in Acute Stroke: Patients’ and Carers’ perspectives J.M.E. Gibson1, C.E. Lightbody2, B. French3, A. McLoughlin4, J. Fitzgerald5, A.M. Gibson6, J..J McAdam7, E. Day8, P. Davies9, H. Emsley10, G. Ford11, C. Price12, C. May13, M. O’Donnell14, C.L. Watkins15 Acute Stroke Telemedicine: Utility, Training and Evaluation (ASTUTE) University of Central Lancashire, Preston, UNITED KINGDOM1, University of Central Lan-cashire, Preston, UNITED KINGDOM2, University of Central Lancashire, Preston, UNITED KINGDOM3, University of Central Lancashire, Preston, UNITED KINGDOM4, University of Cen-tral Lancashire, Preston, UNITED KINGDOM5, University of Central Lancashire, Preston, UNIT-ED KINGDOM6, University of Central Lancashire, Preston, UNITED KINGDOM7, Cardiac and Stroke Networks Lancashire and Cumbria, Preston, UNITED KINGDOM8, North Cumbria Uni-versity Hospitals NHS Trust, Carlisle, UNITED KINGDOM9,Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UNITED KINGDOM10, University of Newcastle, Newcastle upon Tyne, UNITED KINGDOM11, Wansbeck General Hospital, Ashington, UNITED KINGDOM12, University of Southampton, Southampton, UNITED KINGDOM13, Blackpool Teaching Hospitals NHS Foun-dation Trust, Blackpool, UNITED KINGDOM14, University of Central Lancashire, Preston, UNIT-ED KINGDOM15 Background: Telemedicine can facilitate the delivery of thrombolysis in acute stroke. Development of reliable and acceptable telemedicine systems necessitates taking account of patients’ and carers’ perspectives. We constructed a Standardised Telemedicine Toolkit for the implementation of tele-medicine in the UK. The Toolkit is currently being tested in practice and the consequences for pa-tients evaluated. Method: The Toolkit was used in the real-time assessment of patients with suspected stroke. Sub-sequently, patients’ and carers’ views of its acceptability and feasibility were explored through semi-structured interviews to gain their views of the delivery of telemedicine assessment, e.g. ac-ceptability of the technology and perceptions of the knowledge and skills of clinical users. Inter-views were transcribed verbatim and analysed using thematic analysis. Results: We analysed findings from interviews with 24 service users; 19 were patients and 5 were carers. No patients experienced significant post-thrombolysis complications. Sixteen codes, clus-tered into four themes, were identified from initial coding and refined via further analysis. Themes were: information and understanding of telemedicine; the telemedicine process; support; evaluation. Key findings included: Positive opinions of the value and importance of telemedicine; willingness to be involved in the telemedicine consultation even from self-stated “technophobes”; confidence in the skills of bedside staff and decision-support providers; positive appraisal of the system; opinions of the system compared to face-to-face consultation varied. Conclusions: Telemedicine appears to be mostly well-accepted by patients and carers. Staff train-ing and experience with the system seem important in improving its acceptability. The findings will inform the further development of the online Standardised Toolkit at http://www.astute-telestroke. org.uk. 612 Acute stroke: emergency management, stroke units and complications A regional emergency stroke network yields a high rate of thrombolysis. The Resuval (Rhône Valley, France) thrombolysis registry. L. DEREX1, F. PHILIPPEAU2, K. BLANC-LASSERRE3, S. CAKMAK4, A.E VALLET5, E. FLO-CARD6, M. BISCHOFF7, B. FERROUD-PLATTET8, T. RUSTERHOLTZ9, N. NIGHOGHOS-SIAN10, C. EL KHOURY11 NEUROLOGICAL HOSPITAL, STROKE UNIT, LYON, FRANCE1, STROKE UNIT, NEU-ROLOGY, BOURG EN BRESSE, FRANCE2, STROKE UNIT, NEUROLOGY, VALENCE, FRANCE3, STROKE UNIT, NEUROLOGY, VILLEFRANCHE SUR SAONE, FRANCE4, STROKE UNIT, NEUROLOGY, VIENNE, FRANCE5, RESUVAL EMERGENCY NETWORK, VIENNE, FRANCE6, RESUVAL EMERGENCY NETWORK, VIENNE, FRANCE7, ARS RHONE ALPES, LYON, FRANCE8, ARS RHONE ALPES, LYON, FRANCE9,NEUROLOGICAL HOS-PITAL, STROKE UNIT, LYON, FRANCE10, RESUVAL EMERGENCY NETWORK, VIENNE, FRANCE11 Background We present the first data following the establishment of a regional emergency stroke network in the Rhône Valley, France (Resuval stroke network - five stroke units) covering a popu-lation of 3 million people. This network focuses on dense regional stroke unit coverage and on the establishment of a standardised protocol for pre-hospital management with high priority of emer-gency transport, and neurologist and radiologist pre-notification of the arrival of a suspected stroke victim. Methods We prospectively evaluated all patients receiving thrombolysis for acute ischaemic stroke (AIS) in the network from October 1, 2010 to June 30, 2012. Results Six hundred fifty-six AIS patients have received urgent reperfusion treatment (96% IV thrombolysis, 2% combined IV and IA thrombolysis, 2% thrombectomy alone). During the observation period, a total of 7 193 AIS occurred in the population covered by the network (thrombolysis rate: 9.1%). Median age of patients who received reperfusion therapy was 73 (161 patients≥ 80 years – 24.5% of all thrombolytic treat-ments). Fifty-five % were men. Median distance from the place of stroke to the stroke unit was 19 km. Initial reaction was direct activation of Emergency Medical Services in 76% of cases. Eighty-three % of patients were primarily referred to a hospital with stroke unit on site. Median baseline NIHSS score was 11. Pre-treatment MRI was performed in 74% of cases. The rate of proximal arte-rial occlusion was 41% (Internal carotid artery: 13%, M1 middle cerebral artery: 24%, basilar artery: 4%). Median time from stroke onset (SO) to first medical contact was 38 min, from SO to admis-sion: 1 h 35 min, from admission to brain imaging: 17 min, from SO to thrombolysis: 2 h 35 min. Sixty-seven % of patients were treated within the first three hours and 30% between 3 h and 4.5 h. The rate of symptomatic haemorrhage (ECASS citeria) was 3.5%. At 3 months, 41% of patients had a modified Rankin Scale (m-RS) score ≤ 1 and 54% had a m-RS score ≤ 2. Conclusion The estab-lishment of a regional stroke network yields high rates of early stroke unit admission, thrombolysis and clinical recovery.
Karger_ESC London_2013
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