Telemedicine-assisted Treatment of Patients With ICH
Object Telemedicine provides a new approach to improve stroke care in community settings, delivering acute stroke expertise to hospitals in rural areas. Given the controversies in many aspects of the treatment of intracerebral hemorrhage (ICH) and the lack of guidelines, a prompt neurosurgical second opinion may facilitate the treatment of patients with ICH. Here, the authors' 8-year experience with the use of telemedicine in the management of ICH is reported.
Methods The medical records of patients with ICH treated through a telemedicine system in the district of Messina, Italy, between June 2003 and June 2011 were retrospectively reviewed. Neuroradiological and clinical data for patients were transmitted through a high-technology "hub-and-spoke" telemedicine network. Neurosurgical teleconsulting (at the hub) was available for 7 peripheral hospitals (spokes) serving about 700,000 people. The authors analyzed 1) the time between peripheral hospital admission and the specialized second opinion consultation, 2) primary and secondary transfers to the authors' neurosurgery department, and 3) the treatments (surgical or medical) of patients transferred to the hub.
Results The telemedicine network was used to treat more than 2800 patients, 733 with ICH. A neurosurgical consultation was provided in 38 minutes versus 160 minutes for a consultation without telemedicine. One hundred seventy-six (24%) of 733 patients were primarily transferred to the hub. Ninety-five patients (13%) underwent surgical treatment. The remaining 81 patients (11%) underwent neurointensive care. Eight (1.4%) of 557 patients treated at the spokes needed a secondary transfer for surgical treatment because of a worsening clinical condition and/or CT findings. Considering secondary and inappropriate transfers, the interpretation of data was correct in 96.5% of cases.
Conclusions Telemedicine allowed rapid visualization of neuroradiological and clinical data, providing neurosurgical expertise to community hospitals on demand and within minutes. It allowed the treatment of patients at peripheral hospitals and optimized resources. A small percentage of patients treated at the peripheral hospitals had secondary deterioration. Telemedicine allowed fast patient transfer when necessary and provided improved accuracy in patient care.
Intracerebral hemorrhage accounts for 15%–30% of all acute strokes, with an incidence of approximately 12–15 cases/100,000 persons/year. Overall mortality from ICH is worse than that from ischemic stroke, approaching 50% at 30 days after hemorrhage, and patients who survive are independent at 6 months after ICH in less than 20% of cases. Because of its frequency and dramatic impact on the neurological status of patients, ICH is one of the most frequent clinical conditions for which an emergency neurosurgical consultation is required. An expert opinion is needed to coordinate the best patient care, because there are no guidelines for the management of many aspects of ICH, including the choice of medical versus surgical treatment. Telemedicine is the ideal means of immediately providing this consultation for patients admitted to peripheral hospitals.
"Telemedicine," a term coined in the 1970s, is the use of information and communication technology to improve patient outcomes by increasing access to care, medical information, and evidence-based clinical practice. It includes consultative, diagnostic, and treatment services with the aim of improving patient care and the efficacy of the diagnostic and therapeutic strategies at the peripheral hospitals.
Many studies have shown that telemedicine improves the care of patients with ischemic stroke who have been admitted to peripheral hospitals, allowing for the quick selection of candidates for thrombolytic therapy and eventually improving the long-term neurological outcome. However, studies focused on the role of telemedicine in the treatment of patients with ICH in an acute setting are missing. The aim of the present study was to analyze the role of a telemedicine network in the treatment of patients with spontaneous ICH in terms of a faster neurosurgical evaluation and selection of patients who are the best candidates for direct neurosurgical or neurointensive care.
Abstract and Introduction
Abstract
Object Telemedicine provides a new approach to improve stroke care in community settings, delivering acute stroke expertise to hospitals in rural areas. Given the controversies in many aspects of the treatment of intracerebral hemorrhage (ICH) and the lack of guidelines, a prompt neurosurgical second opinion may facilitate the treatment of patients with ICH. Here, the authors' 8-year experience with the use of telemedicine in the management of ICH is reported.
Methods The medical records of patients with ICH treated through a telemedicine system in the district of Messina, Italy, between June 2003 and June 2011 were retrospectively reviewed. Neuroradiological and clinical data for patients were transmitted through a high-technology "hub-and-spoke" telemedicine network. Neurosurgical teleconsulting (at the hub) was available for 7 peripheral hospitals (spokes) serving about 700,000 people. The authors analyzed 1) the time between peripheral hospital admission and the specialized second opinion consultation, 2) primary and secondary transfers to the authors' neurosurgery department, and 3) the treatments (surgical or medical) of patients transferred to the hub.
Results The telemedicine network was used to treat more than 2800 patients, 733 with ICH. A neurosurgical consultation was provided in 38 minutes versus 160 minutes for a consultation without telemedicine. One hundred seventy-six (24%) of 733 patients were primarily transferred to the hub. Ninety-five patients (13%) underwent surgical treatment. The remaining 81 patients (11%) underwent neurointensive care. Eight (1.4%) of 557 patients treated at the spokes needed a secondary transfer for surgical treatment because of a worsening clinical condition and/or CT findings. Considering secondary and inappropriate transfers, the interpretation of data was correct in 96.5% of cases.
Conclusions Telemedicine allowed rapid visualization of neuroradiological and clinical data, providing neurosurgical expertise to community hospitals on demand and within minutes. It allowed the treatment of patients at peripheral hospitals and optimized resources. A small percentage of patients treated at the peripheral hospitals had secondary deterioration. Telemedicine allowed fast patient transfer when necessary and provided improved accuracy in patient care.
Introduction
Intracerebral hemorrhage accounts for 15%–30% of all acute strokes, with an incidence of approximately 12–15 cases/100,000 persons/year. Overall mortality from ICH is worse than that from ischemic stroke, approaching 50% at 30 days after hemorrhage, and patients who survive are independent at 6 months after ICH in less than 20% of cases. Because of its frequency and dramatic impact on the neurological status of patients, ICH is one of the most frequent clinical conditions for which an emergency neurosurgical consultation is required. An expert opinion is needed to coordinate the best patient care, because there are no guidelines for the management of many aspects of ICH, including the choice of medical versus surgical treatment. Telemedicine is the ideal means of immediately providing this consultation for patients admitted to peripheral hospitals.
"Telemedicine," a term coined in the 1970s, is the use of information and communication technology to improve patient outcomes by increasing access to care, medical information, and evidence-based clinical practice. It includes consultative, diagnostic, and treatment services with the aim of improving patient care and the efficacy of the diagnostic and therapeutic strategies at the peripheral hospitals.
Many studies have shown that telemedicine improves the care of patients with ischemic stroke who have been admitted to peripheral hospitals, allowing for the quick selection of candidates for thrombolytic therapy and eventually improving the long-term neurological outcome. However, studies focused on the role of telemedicine in the treatment of patients with ICH in an acute setting are missing. The aim of the present study was to analyze the role of a telemedicine network in the treatment of patients with spontaneous ICH in terms of a faster neurosurgical evaluation and selection of patients who are the best candidates for direct neurosurgical or neurointensive care.