Telemedizin in der akuten Schlaganfallversorgung

Zusammenfassung

Telemedizinische Anwendungen mit klinischer Untersuchung des Patienten über Videokonferenz und Fernbefundung der zerebralen Schnittbildgebung haben verbreitete Nutzung in der akuten Schlaganfallversorgung insbesondere in Regionen mit unzureichenden neurologischen Behandlungseinrichtungen gefunden. Wissenschaftliche Untersuchungen haben die Zuverlässigkeit der neurologischen Fernuntersuchung bestätigt und die Indikation für die systemische Lysetherapie kann über Telekonsile mit entsprechenden technischen Qualitätsstandards sicher gestellt werden. Eine Verbesserung klinischer Behandlungsergebnisse konnte bisher aber nur gezeigt werden, wenn die Telemedizin in das Konzept der Stroke Unit mit spezialisierten Schlaganfalleinheiten und entsprechenden Qualitätsstandards eingebettet wurde. Außerhalb eines derartigen integrierten Konzeptes ist ein klinisches Benefit nicht nachgewiesen. Forschungsbedarf besteht im Bereich der Kosteneffizienz, des Qualitätsmanagements und der Implementierung weiterer technologischer Innovationen. Der Einsatz der Telemedizin in der Prävention, prähospitalen Schlaganfallversorgung, Rehabilitation und ambulanten Nachsorge ist nicht ausreichend untersucht und bedarf einer konsequenten wissenschaftlichen Evaluation.

Abstract

Telemedicine is increasingly being utilised for the remote evaluation of stroke patients, particularly in neurologically underserved areas. It is usually based on video examination and teleradiological evaluations of brain scans. Scientific analyses have demonstrated the reliability of neurological scores assessed via videoconference. Teleradiology using electronically transmitted original imaging data is potentially equivalent to onsite assessment. Intravenous thrombolysis can be indicated with similar results as in experienced stroke centres if both technological and professional quality standards are applied. However, improved clinical outcomes of stroke patients have only been shown when telemedicine was combined with the Stroke Unit concept based on specialised stroke wards and organised stroke care. More scientific evaluation is needed in the fields of cost effectiveness, quality management and implementation of further technological innovations. There are still insufficient data about the use of telemedicine in prevention, rehabilitation and post-stroke care and a comprehensive scientific evaluation is still needed.

Schlaganfall - Telemedizin - Stroke Unit - Qualität - Thrombolyse

stroke - telemedicine - stroke unit - quality - thrombolysis

Literatur

• 1 Kolominsky-Rabas P L, Heuschmann P U, Marschall D. et al . Lifetime cost of ischemic stroke in Germany: results and national projections from a population-based stroke registry: the Erlangen Stroke Project.  Stroke. 2006;  37 1179-1183
• 2 Sandercock P, Gubitz G, Foley P. et al . Antiplatelet therapy for acute ischaemic stroke.  Cochrane Database Syst Rev. 2003;  , CD000029
• 3 Langhorne P. Organised inpatient (stroke unit) care for stroke.  Cochrane Database Syst Rev. 2007;  , CD000197
• 4 Hacke W, Donnan G, Fieschi C. et al . Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials.  Lancet. 2004;  363 768-774
• 5 Vahedi K, Hofmeijer J, Juettler E. et al . Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials.  Lancet Neurol. 2007;  6 215-222
• 6 Weimar C, Ringelstein E B, Diener H C. [Monitoring stroke units: management, outcome, efficiency].  Nervenarzt. 2007;  78 957-966
• 7 Daffertshofer M, Mielke O, Pullwitt A. et al . Transient ischemic attacks are more than „ministrokes”.  Stroke. 2004;  35 2453-2458
• 8 Leys D, Ringelstein E B, Kaste M. et al . Facilities available in European hospitals treating stroke patients.  Stroke. 2007;  38 2985-2991
• 9 Levine S R, Gorman M. „Telestroke”: the application of telemedicine for stroke.  Stroke. 1999;  30 464-469
• 10 Handschu R, Littmann R, Reulbach U. et al . Telemedicine in emergency evaluation of acute stroke: interrater agreement in remote video examination with a novel multimedia system.  Stroke. 2003;  34 2842-2846
• 11 Audebert H J, Wimmer M L, Hahn R. et al . Can Telemedicine Contribute to Fulfill WHO Helsingborg Declaration of Specialized Stroke Care?.  Cerebrovasc Dis. 2005;  20 362-369
• 12 Wiborg A, Widder B. Teleneurology to improve stroke care in rural areas: The Telemedicine in Stroke in Swabia (TESS) Project.  Stroke. 2003;  34 2951-2956
• 13 Gahn G, Becker U, Goldhagen T. et al . Schlaganfall-Ostsachsen-Netzwerk (SOS-NET): Aufbau einer flächendeckenden Schlaganfallversorgung auf Basis eines unabhängigen Qualitätsmanagments (Abstract).  Akt Neurol. 2008;  35 94
• 14 Hubble J P, Pahwa R, Michalek D K. et al . Interactive video conferencing: a means of providing interim care to Parkinson's disease patients.  Mov Disord. 1993;  8 380-382
• 15 Craig J J, McConville J P, Patterson V H. et al . Neurological examination is possible using telemedicine.  J Telemed Telecare. 1999;  5 177-181
• 16 Wiborg A, Widder B, Riepe M. et al . Beitrag der Telemedizin zur flächendeckenden Schlaganfallversorgung in ländlichen Gebieten (German).  Akt Neurol. 2000;  27 119-124
• 17 Shafqat S, Kvedar J C, Guanci M M. et al . Role for telemedicine in acute stroke. Feasibility and reliability of remote administration of the NIH stroke scale.  Stroke. 1999;  30 2141-2145
• 18 Wang S, Lee S B, Pardue C. et al . Remote evaluation of acute ischemic stroke: reliability of National Institutes of Health Stroke Scale via telestroke.  Stroke. 2003;  34 e188-e191
• 19 Meyer B C, Lyden P D, Al Khoury L. et al . Prospective reliability of the STRokE DOC wireless / site independent telemedicine system.  Neurology. 2005;  64 1058-1060
• 20 Yamada M, Watarai H, Andou T. et al . Emergency image transfer system through a mobile telephone in Japan: technical note.  Neurosurgery. 2003;  52 986-988
• 21 Johnston K C, Worrall B B. Teleradiology Assessment of Computerized Tomographs Online Reliability Study (TRACTORS) for acute stroke evaluation.  Telemed J E Health. 2003;  9 227-233
• 22 Handschu R, Tomandl B, Littmann R. et al . Telemedicine in Stroke Managment (Abstract).  Cerebrovasc Dis. 2003;  16 S59
• 23 Llanes J N, Kidwell C S, Starkman S. et al . The Los Angeles Motor Scale (LAMS): a new measure to characterize stroke severity in the field.  Prehosp Emerg Care. 2004;  8 46-50
• 24 Kidwell C S, Starkman S, Eckstein M. et al . Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS).  Stroke. 2000;  31 71-76
• 25 Bray J E, Martin J, Cooper G. et al . Paramedic identification of stroke: community validation of the melbourne ambulance stroke screen.  Cerebrovasc Dis. 2005;  20 28-33
• 26 Liferidge A T, Brice J H, Overby B A. et al . Ability of laypersons to use the Cincinnati Prehospital Stroke Scale.  Prehosp Emerg Care. 2004;  8 384-387
• 27 Ziegler V, Rashid A, Muller-Gorchs M. et al . [Mobile computing systems in preclinical care of stroke: Results of the Stroke Angel initiative within the BMBF project PerCoMed.].  Anaesthesist. 2008;  57 677-685
• 28 Kleindorfer D O, Miller R, Moomaw C J. et al . Designing a message for public education regarding stroke: does FAST capture enough stroke?.  Stroke. 2007;  38 2864-2868
• 29 Nor A M, McAllister C, Louw S J. et al . Agreement between ambulance paramedic- and physician-recorded neurological signs with Face Arm Speech Test (FAST) in acute stroke patients.  Stroke. 2004;  35 1355-1359
• 30 LaMonte M P, Cullen J, Gagliano D M. et al . TeleBAT: mobile telemedicine for the Brain Attack Team.  J Stroke Cerebrovasc Dis. 2000;  9 128-135
• 31 LaMonte M P, Bahouth M N, Hu P. et al . Telemedicine for acute stroke: triumphs and pitfalls.  Stroke. 2003;  34 725-728
• 32 Wang S, Gross H, Lee S B. et al . Remote evaluation of acute ischemic stroke in rural community hospitals in Georgia.  Stroke. 2004;  35 1763-1768
• 33 Schwamm L H, Rosenthal E S, Hirshberg A. et al . Virtual TeleStroke support for the emergency department evaluation of acute stroke.  Acad Emerg Med. 2004;  11 1193-1197
• 34 Waite K, Silver F, Jaigobin C. et al . Telestroke: a multi-site, emergency-based telemedicine service in Ontario.  J Telemed Telecare. 2006;  12 141-145
• 35 Choi J Y, Porche N A, Albright K C. et al . Using telemedicine to facilitate thrombolytic therapy for patients with acute stroke.  Jt Comm J Qual Patient Saf. 2006;  32 199-205
• 36 Audebert H J, Kukla C, Clarmann C von. et al . Telemedicine for safe and extended use of thrombolysis in stroke: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria.  Stroke. 2005;  36 287-291
• 37 Meyer B C, Raman R, Hemmen T. et al . Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study.  Lancet Neurol. 2008;  7 787-795
• 38 Vatankhah B, Schenkel J, Furst A. et al . Telemedically Provided Stroke Expertise beyond Normal Working Hours. The Telemedical Project for Integrative Stroke Care.  Cerebrovasc Dis. 2008;  25 332-337
• 39 Audebert H J, Schenkel J, Heuschmann P U. et al . Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany.  Lancet Neurol. 2006;  5 742-748
• 40 Audebert H J, Kukla C, Vatankhah B. et al . Comparison of tissue plasminogen activator administration management between Telestroke Network hospitals and academic stroke centers: the Telemedical Pilot Project for Integrative Stroke Care in Bavaria / Germany.  Stroke. 2006;  37 1822-1827
• 41 Schwab S, Vatankhah B, Kukla C. et al . Long-term outcome after thrombolysis in telemedical stroke care.  Neurology. 2007;  69 898-903
• 42 Wahlgren N, Ahmed N, Davalos A. et al . Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study.  Lancet. 2007;  369 275-282
• 43 Katzan I L, Furlan A J, Lloyd L E. et al . Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience.  JAMA. 2000;  283 1151-1158
• 44 Katzan I L, Hammer M D, Furlan A J. et al . Quality improvement and tissue-type plasminogen activator for acute ischemic stroke: a Cleveland update.  Stroke. 2003;  34 799-800
• 45 Heuschmann P U, Kolominsky-Rabas P L, Roether J. et al . Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy.  JAMA. 2004;  292 1831-1838
• 46 Frey J L, Jahnke H K, Goslar P W. et al . tPA by telephone: extending the benefits of a comprehensive stroke center.  Neurology. 2005;  64 154-156
• 47 Audebert H J, Clarmann C von, Schenkel J. et al . Problemfeld der Notfallverlegungen beim Schlaganfall. Ergebnisse des telemedizinischen Pilotprojektes zur integrierten Schlaganfallversorgung in Südostbayern (TEMPiS).  Dtsch Med Wochenschr. 2005;  130 2495-2500
• 48 Muller R, Pfefferkorn T, Vatankhah B. et al . Admission facility is associated with outcome of basilar artery occlusion.  Stroke. 2007;  38 1380-1383
• 49 Deutsche Schlaganfall-Gesellschaft .Mindestkriterien für Telemedizin in der Schlaganfallversorgung. Pressemitteilung 5–2008. http://www.dsg-info.de 2008 Ref Type: Internet Communication
• 50 Audebert H J, Schultes K, Tietz V. et al . Long-term effects of specialized stroke care with telemedicine support in community hospitals. On behalf of the Telemedical Project for Integrative Stroke Care (TEMPiS).  Stroke. 2008;  , published online, DOI: DOI: 10.1161/STROKEAHA.108.529255
• 51 Müller H, Nimmrichter B, Schenkel J. et al . Verbesserung der Schlaganfall-Behandlung in einem regionalen Versorgungskrankenhaus; Prozessqualität vor und nach Einbindung in ein telemedizinisch unterstütztes Schlaganfall-Netzwerk.  Dtsch Med Wochenschr. 2006;  131 1309-1314
• 52 Audebert H J, Boy S, Jankovits R. et al . Is Mobile Teleconsulting Equivalent to Hospital Based Telestroke Services?.  Stroke. 2008;  , epub ahead of print
• 53 Piron L, Tonin P, Atzori A M. et al . Virtual environment system for motor tele-rehabilitation.  Stud Health Technol Inform. 2002;  85 355-361
• 54 Adamovich S V, Merians A S, Boian R. et al . A virtual reality based exercise system for hand rehabilitation post-stroke: transfer to function.  Conf Proc IEEE Eng Med Biol Soc. 2004;  7 4936-4939
• 55 Palsbo S E. Equivalence of functional communication assessment in speech pathology using videoconferencing.  J Telemed Telecare. 2007;  13 40-43
• 56 Cleland J G, Louis A A, Rigby A S. et al . Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study.  J Am Coll Cardiol. 2005;  45 1654-1664
• 57 Vontetsianos T, Giovas P, Katsaras T. et al . Telemedicine-assisted home support for patients with advanced chronic obstructive pulmonary disease: preliminary results after nine-month follow-up.  J Telemed Telecare. 2005;  11 (Suppl. 1) 86-88