Implementierung eines landesweiten telemedizinischen Schlaganfallnetzwerks

2018 ◽  
Vol 45 (08) ◽  
pp. 586-591
Author(s):  
Frederick Palm ◽  
Johannes Wöhrle ◽  
Matthias Maschke ◽  
Annette Spreer ◽  
Klaus Gröschel ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Demografischer Wandel ◽  
Mechanische Thrombektomie ◽  
Stroke Units ◽  
Stroke Mimics ◽  
Intrazerebrale Blutungen

Zusammenfassung Hintergrund Demografischer Wandel, Urbanisierung sowie eine zunehmende Spezialisierung der Akutversorgung von Schlaganfallpatienten erfordern eine Anpassung von Versorgungsstrukturen mit dem Ziel, auch Patienten in ländlichen Regionen leitliniengerecht behandeln zu können. Methodik Im Frühjahr 2016 wurde ein landesweites telemedizinisches Schlaganfallnetzwerk unter Einbeziehung aller 6 überregionalen Stroke Units im Land Rheinland-Pfalz etabliert. Die Zuständigkeit für den Konsildienst wechselt täglich zwischen den Kliniken und steht rund um die Uhr zur Verfügung. Alle Kriterien des OPS 8.98b werden erfüllt. Am Netzwerk teilnehmen können alle regionalen Stroke Units und Kliniken, die prädefinierte Kriterien erfüllen und nicht in regionaler Konkurrenz mit etablierten Stroke Units stehen. Ergebnisse Zu Projektbeginn am 01.04. 2016 nahmen 6 Kliniken teil, die alle eine regionale Stroke Unit unter internistischer Leitung besitzen. Innerhalb des ersten Jahres erfolgten 1568 telemedizinische Konsile. Die Diagnosen waren ischämische Infarkte (n = 802 Patienten; 51,2 %), intrazerebrale Blutungen (n = 46; 2,9%), transitorisch ischämische Attacken (TIA; n = 319; 20,4 %) und nicht vaskuläre Ursachen (sog. Stroke Mimics; n = 400; 25,5 %). Die Latenz zwischen Klinikaufnahme und Konsilbeginn betrug im Median 21 Minuten (Interquartilrange (IQR) 22 Minuten), die mediane Konsildauer lag bei 24 Minuten (IQR 22 Minuten). Bei den Patienten mit ischämischen Schlaganfällen betrug die Lyserate 12,5 % (n = 100). Eine mechanische Thrombektomie wurde nach Weiterverlegung in eines der Zentren bei 4,6 % (n = 37) der Patienten durchgeführt. Schlussfolgerung Die telemedizinische Netzwerkbildung ist geeignet, die landesweite Versorgung von Schlaganfallpatienten sicherzustellen. Weitere Analysen, insbesondere zum Outcome, werden benötigt.

Abstract 5: Management Of Intravenous tPA In Non-ICU Environments: Safety, Clinical Outcome, And Cost Savings

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Kisha C Coleman ◽  
Paola Palazzo ◽  
Reza B Shahripour ◽  
Amy L Brooks ◽  
Mary A Cronin ◽  
...  
Keyword(s):  
Critical Care ◽  
Stroke Unit ◽  
Cost Savings ◽  
Pressure Control ◽  
Cardiac Monitoring ◽  
Arterial Line ◽  
Systemic Hemodynamic ◽  
Stroke Units ◽  
Critical Care Admission ◽  
Iv Tpa

Background: Administration of IV tPA has traditionally necessitated admission to an ICU solely for monitoring, with relatively no need for extensive critical care services. Stroke Units that are capable of monitoring IV tPA patients have been proposed to reduce ICU use, but limited data exist that demonstrate safety. We report the largest series of non-ICU managed tPA cases in relation to safety and discharge outcomes. Methods: Consecutive cases admitted to our intermediate-level Stroke Unit spanning 2009-2011 were assembled. Unit capabilities include IV tPA management with nicardipine infusion for blood pressure control as needed, non-invasive or direct central/arterial line and cardiac monitoring, and BiPAP ventilation. Stroke Unit nurses underwent extensive orientation and participate in NET SMART Junior for continuing education. Overall sICH, and drip/ship sICH (parenchymal hemorrhage in combination with > 4 point increase on the NIHSS), systemic hemorrhage, and tPA related death rates were calculated, along with discharge mRS and total ICU cost savings per day. Results: A total of 302 Stroke Unit admissions for intravenous tPA occurred over the 3 year period, while another 31 (10%) were excluded due to critical care admission for systemic hemodynamic or pulmonary instability. Nicardipine infusions were used in 9 (10.5%) Stroke Unit tPA cases in 2009, 10 (9%) in 2010, and 14 (13%) in 2011. Overall sICH rate was 3.3% (n=10) and systemic hemorrhage rate was 2.9% (n=9) with 5 of these (56%) requiring transfusion. Estimated cost savings in total for this 3 year period was $362,400 for “avoided” ICU days. Conclusions: Intravenous tPA patients may be safely managed on non-ICU Stroke Units when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for management of tPA monitoring needs may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit.

Abstract WP72: Early Experience on Intravenous Tissue Plasminogen Activator Delivery in Mobile Stroke Unit Patients with Stroke Mimics

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lila E Sheikhi ◽  
Stacey Winners ◽  
Pravin George ◽  
Andrew Russman ◽  
Zeshaun Khawaja ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Unit ◽  
Early Experience ◽  
Final Diagnosis ◽  
Stroke Mimics ◽  
Intravenous Tissue Plasminogen Activator ◽  
Mobile Stroke Unit ◽  
Tissue Plasminogen ◽  
Iv Tpa

Background: A mobile stroke unit (MSU) allows for early delivery for intravenous tissue plasminogen activator (IV-tPA). A proportion of IV-tPA treated patients may turn out to be stroke mimics. We evaluated the rate and complications seen in stroke mimics treated with tPA from our early experience on MSU. Methods: Retrospective review of patients treated with IV-tPA on the MSU from 2014 to 2016. Charts were reviewed for confirmed strokes by imaging (MRI or CT) and hemorrhagic transformation. Stroke mimics were defined as those without imaging evidence of infarction and a final diagnosis which was not suspected to be stroke. Results: Among 62 patients treated with IV-tPA, 14 (28.6%) had a final diagnosis consistent with a stroke mimics. The majority of these occurred in the first year of the MSU program. Most common mimics included conversion disorder (n=5) and seizures (n=5). While the last known well to IV-tPA times were similar, the MSU door-to-needle time was significantly longer in stroke mimics (38 vs 31 minutes, p = 0.03). No intracerebral hemorrhages or other IV-tPA related complications were identified in the stroke mimics group. Conclusions: In our early experience with MSU, treatment of stroke mimics occurred without IV-tPA related complications. This does not appear to be due to rushed decision making.

Incidence and outcome of functional stroke mimics admitted to a hyperacute stroke unit

2015 ◽  
Vol 88 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Sergios Gargalas ◽  
Robert Weeks ◽  
Najma Khan-Bourne ◽  
Paul Shotbolt ◽  
Sara Simblett ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Mimics ◽  
Hyperacute Stroke

Stroke Rehabilitation 2007: What Should it Be?

2007 ◽  
Vol 2 (3) ◽  
pp. 191-200 ◽  
Author(s):  
Helen M. Dewey ◽  
Lisa J. Sherry ◽  
Janice M. Collier
Keyword(s):  
Stroke Unit ◽  
Stroke Rehabilitation ◽  
Number Needed To Treat ◽  
Stroke Patients ◽  
High Quality ◽  
High Quality Research ◽  
Stroke Units ◽  
Proven Efficacy ◽  
Stroke Unit Care ◽  
Medical Wards

Background There are an estimated 62 million stroke survivors worldwide. The majority will have long-term disability. Despite this reality, there have been few large, high-quality randomized controlled trials of stroke rehabilitation interventions. Summary of review There is excellent evidence for the effectiveness of a number of stroke rehabilitation interventions, notably care of stroke patients in inpatient stroke units and stroke rehabilitation units providing organized, goal-focused care via a multidisciplinary team. Stroke units (in comparison with care on general medical wards) effectively reduce death and disability with the number needed to treat to prevent one person from failing to regain independence being 20. Unfortunately, only a minority of stroke patients have access to stroke unit care. The key principles of effective stroke rehabilitation have been identified. These include ( 1 ) a functional approach targeted at specific activities e.g. walking, activities of daily living, ( 2 ) frequent and intense practice, and ( 3 ) commencement in the first days or weeks after stroke. Conclusion The most effective approaches to restoration of brain function after stroke remain unknown and there is an urgent need for more high-quality research. In the meantime, simple, broadly applicable stroke rehabilitation interventions with proven efficacy, particularly stroke unit care, must be applied more widely.

Interventionelle Therapie des Schlaganfalls – ein interdisziplinärer Ansatz

2017 ◽  
Vol 6 (06) ◽  
pp. 431-439
Author(s):  
Frank Erbguth
Keyword(s):  
Stroke Unit ◽  
Interventionelle Therapie ◽  
Interdisziplinäre Kooperation ◽  
Mechanische Thrombektomie ◽  
Interdisziplinärer Ansatz ◽  
Flächendeckende Versorgung

ZusammenfassungDie mechanische Thrombektomie (MT) von Verschlüssen großer Hirngefäße in Kombination mit der systemischen intravenösen Thrombolyse (IVT) hat sich in den letzten Jahren zu einem hocheffektiven evidenzbasierten Verfahren der Akuttherapie des Hirninfarkts entwickelt. Die Chance auf ein behinderungsfreies Überleben der in der Regel schwer betroffenen Patienten wird um ca. 75% erhöht. Allerdings stellt die MT nur für etwa 5% der Patienten mit ischämischem Schlaganfall eine Therapieoption dar. Die Akuttherapie der ischämischen Schlaganfälle fußt daher weiter hauptsächlich auf den etablierten Maßnahmen wie Stroke-Unit-Behandlung, frühe Sekundärprophylaxe und IVT. Die flächendeckende Versorgung der Kandidaten für eine MT stellt eine logistische Herausforderung dar, zu denen auch die Optimierung der interdisziplinären Zusammenarbeit gehört. Die MT hat auch Implikationen für die Akuttherapie oral antikoagulierter Schlaganfallpatienten. Eine moderne Schlaganfallbehandlung erfordert die interdisziplinäre Kooperation von Neurologie, Neuroradiologie, Neurochirurgie, Kardiologie, Gefäßchirurgie und Anästhesie.

scholarly journals European Stroke Organisation certification of stroke units and stroke centres

2018 ◽  
Vol 3 (3) ◽  
pp. 220-226 ◽  
Author(s):  
Ulrike Waje-Andreassen ◽  
Darius G Nabavi ◽  
Stefan T Engelter ◽  
Diederik WJ Dippel ◽  
Damian Jenkinson ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Care ◽  
Evidence Base ◽  
Final Decision ◽  
Major Step ◽  
High Quality ◽  
Stroke Units ◽  
Stroke Treatment ◽  
Research Activities ◽  
Stroke Centre

To improve quality and to overcome the wide discrepancies in stroke care both within- and between European countries, the European Stroke Organisation Executive Committee initiated in 2007 activities to establish certification processes for stroke units and stroke centres. The rapidly expanding evidence base in stroke care provided the mandate for the European Stroke Organisation Stroke Unit-Committee to develop certification procedures for stroke units and stroke centres with the goals of setting standards for stroke treatment in Europe, improving quality and minimising variation. The purpose of this article is to present the certification criteria and the auditing process for stroke units and stroke centres that aim to standardise and harmonise care for stroke patients, and hence become members of the European Stroke Organisation Stroke Unit and Stroke Centre network. Standardised application forms and guidelines for national and international auditors have been developed and updated by members of the European Stroke Organisation Stroke Unit-Committee. Key features are availability of trained personnel, diagnostic equipment, acute treatment and collaboration with other stroke-caregivers. After submission, the application is reviewed by one national and two international auditors. Based on their reports, the Stroke Unit-Committee will make a final decision. Validating on-site visits for a subset of stroke units and stroke centres are planned. We herein describe a novel, European Stroke Organisation-based online certification process of stroke units and stroke centres. This is a major step forward towards high-quality stroke care across Europe. The additional value by connecting high-quality European Stroke Organisation Stroke Unit and Stroke Centre is facilitation of future collaboration and research activities, enabling building and maintenance of a high-quality stroke care network in Europe.

scholarly journals A register-based study comparing planned rehabilitation following acute stroke in 2011 and 2017

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Malin C. Nylén ◽  
Hanna C. Persson ◽  
Tamar Abzhandadze ◽  
Katharina S. Sunnerhagen
Keyword(s):  
Stroke Unit ◽  
Community Hospital ◽  
Binary Logistic Regression ◽  
University Hospital ◽  
Impaired Consciousness ◽  
University Hospitals ◽  
Cross Sectional ◽  
Severe Stroke ◽  
Stroke Units ◽  
Explanatory Variables

AbstractThis cross-sectional, register-based study aimed to explore patterns of planned rehabilitation at discharge from stroke units in Sweden in 2011 and 2017 and identify explanatory variables for planned rehabilitation. Multivariable binary logistic regression was used to identify variables that could explain planned rehabilitation. There were 19,158 patients in 2011 and 16,508 patients in 2017 with stroke, included in the study. In 2011, 57% of patients were planned for some form of rehabilitation at discharge from stroke unit, which increased to 72% in 2017 (p < 0.001). Patients with impaired consciousness at admission had increased odds for planned rehabilitation (hemorrhage 2011 OR 1.43, 95% CI 1.13–1.81, 2017 OR 1.66, 95% CI 1.20–2.32), (IS 2011 OR 1.21, 95% CI 1.08–1.34, 2017 OR 1.49, 95% CI 1.28–1.75). Admission to a community hospital (hemorrhage 2011 OR 0.56, 95% CI 0.43–0.74, 2017 OR 0.39, 95% CI 0.27–0.56) (IS 2011 OR 0.63, 95% CI 0.58–0.69, 2017 OR 0.54, 95% CI 0.49–0.61) or to a specialized non-university hospital (hemorrhage 2017 OR 0.66, 95% CI 0.46–0.94), (IS 2011 OR 0.90, 95% CI 0.82–0.98, 2017 OR 0.76, 95% CI 0.68–0.84) was associated with decreased odds of receiving planned rehabilitation compared to admission to a university hospital. As a conclusion severe stroke was associated with increased odds for planned rehabilitation and patients discharged from non-university hospitals had consistently decreased odds for planned rehabilitation.

scholarly journals The Stroke Unit Story: Where Have We Been and Where Are We Going?

2021 ◽  
pp. 1-8
Author(s):  
Peter Langhorne
Keyword(s):  
Collaborative Research ◽  
Stroke Unit ◽  
Final Section ◽  
Evidence Base ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Stroke Units ◽  
History Of ◽  
Stroke Unit Care ◽  
Stroke Type

<b><i>Background:</i></b> The concept of stroke unit care has been discussed for over 50 years, but it is only in the last 25 years that clear evidence of its effectiveness has emerged to inform these discussions. <b><i>Summary:</i></b> This review outlines the history of the concept of stroke units to improve recovery after stroke and their evaluation in clinical trials. It describes the first systematic review of stroke unit trials published in 1993, the establishment of a collaborative research group (the Stroke Unit Trialists’ Collaboration), the subsequent analyses and updates of the evidence base, and the efforts to implement stroke unit care in routine settings. The final section considers some of the remaining challenges in this area of research and clinical practice. <b><i>Key Messages:</i></b> Good quality evidence confirms that stroke patients who are looked after in a stroke unit are more likely to survive and be independent and living at home 1 year after their stroke. The apparent benefits are independent of patient age, sex, stroke type, or initial stroke severity. The benefits are most obvious in units based in a discrete ward (stroke ward). The current challenges include integrating effective stroke units with more recent systems to deliver hyper-acute stroke interventions and implementing stroke units in lower resource regions.

Organisierte Behandlung in einer Stroke Unit -Voraussetzung zur optimierten Behandlungdes akuten Hirnschlages

2012 ◽  
Vol 69 (9) ◽  
pp. 549-553
Author(s):  
A. Lyrer ◽  
Bonati ◽  
Michel
Keyword(s):  
Stroke Unit ◽  
Stroke Units

Eine Stroke Unit (SU) ist eine Behandlungseinheit eines Spitals, die für Hirnschlagpatienten konzipiert ist. Die Behandlung in einer SU ist für alle Schweregrade und alle Altersgruppen von Patienten mit Hirnschlag wirksam. Sie verfügt über monitorisierte und nicht-monitorisierte Behandlungsplätze. Patienten, die in Stroke Units behandelt werden, haben - im Vergleich zur herkömmlichen, weniger strukturierten Behandlung - eine signifikant höhere Wahrscheinlichkeit zu überleben, ihre Selbständigkeit wieder zu erlangen und nach Hause zurückzukehren. Eine Behandlung in einer organisierten Einheit gewährleistet aber auch die die Applikation von Einzelmaßnahmen, wie z. B. die Thrombolyse, die nachweislich eine Wirksamkeit mit günstigem Einfluss auf den Verlauf haben.

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