Telediagnostik und Telekonsil in Schlaganfallnetzwerken

Zusammenfassung

Die Zuverlässigkeit der neurologischen Fernuntersuchung mittels Videokonferenz bei akuten Schlaganfallpatienten ist gut belegt. Hiervon ausgehend sind international telemedizinische Netzwerke zur Schlaganfallversorgung entstanden, die auf sehr unterschiedlichen Ansätzen basieren. In Deutschland hat sich das Konzept regionaler und integrierter Netzwerke durchgesetzt, das heißt, dass in den telemedizinisch vernetzten Kliniken Schlaganfalleinheiten mit hohen Qualitätsstandards und ein netzwerkübergreifendes Schulungskonzept und Qualitätsmanagement etabliert wurden. Aus dem TEMPiS-Projekt in Süd-Ost-Bayern mit jährlich über 3 000 Telekonsilen und zuletzt ca. 400 Lysebehandlungen in 15 Kooperationskliniken liegen überzeugende Studienergebnisse zum klinischen Nutzen derart konzipierter Netzwerke vor. Dieser Artikel soll einen Einblick in den Aufbau, die technischen Grundlagen und die Evaluationsergebnisse von telemedizinischen Schlaganfallnetzwerken geben und ihre Zukunftsperspektive beschreiben.

Summary

The reliability of remote neurological examinations in a telemedicine setting via videoconference has been proven during the last years. Subsequently several telemedical networks for the acute stroke care have been developed throughout the world following different approaches. In Germany, the concept of regional and integrated networks has been established. High quality stroke units, regular education programs for participating staff and a network controlling quality management are major components of this concept. The TEMPiS project which includes 15 cooperation hospitals is situated in the south-east of Bavaria. More than 3 000 teleconsultations per year are performed and in 2009 more than 400 patients were treated with systemic thrombolysis. This project provides us with substantial published data proving the clinical benefit of the concept of a regional and integrated network. This review outlines the structures, technical data, clinical results and the future perspectives of telemedical stroke networks.

Schlüsselwörter

Telemedizin - Schlaganfall - Telestroke - Netzwerkkonzept

Keywords

Telemedicine - stroke - telestroke - networking

• Literatur

• 1 Audebert HJ. 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; 05: 742-748.
• 2 Audebert HJ. et al. Comparison of Tissue Plasminogen Activator Administration. Management Between Telestroke Network Hospitals and Academic Stroke Centers. Stroke 2006; 37: 1822-1827.
• 3 Audebert HJ. 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 2009; 40: 902-908.
• 4 Audebert HJ. et al. Telemedizin in der akuten Schlaganfallversorgung. Review und Empfehlungen des Kompetenznetzes Schlaganfall. Akt Neurol 2009; 36: 82-90.
• 5 Handschu R. 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.
• 6 Handschu R. et al. Telemedicine in acute stroke: remote video-examination compared to simple telephone consultation. J Neurol 2008; 255: 1792-1797.
• 7 Johnston KC, Worrall BB. Teleradiology assessment of computerized tomographs online reliabilty study (TRACTORS) for acute stroke evaluation. Telemed J E Health 2003; 09: 227-233.
• 8 Kolominsky-Rabas PL. 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.
• 9 Levine SR, Gorman M. “Telestroke”: The application of telemedicine for stroke. Stroke 1999; 30: 464-469.
• 10 Leys D, Ringelstein EB, Kaste M, Hacke W. Facilities available in European hospitals treating stroke patients. Stroke 2007; 38: 2985-2991.
• 11 Meyer BC. et al. Prospective reliability of the STRokE DOC wireless/site independent telemedicine system. Neurology 2005; 64: 1058-1060.
• 12 Meyer BC. et al. Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. Lancet Neurol 2008; 07: 787-795.
• 13 Pervez MA. et al. Remote supervision of iv-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe. Stroke 2010; 41: e18-e24.
• 14 Ringelstein EB. et al. Konzept der überregionalen und regionalen Schlaganfallversorgung in Deutschland. Akt Neurologie 2000; 27: 101-103.
• 15 Schwab S. et al. Long term outcome after thrombolysis in telemedical stroke care. Neurology 2007; 69: 898-903.
• 16 Schwamm LH. et al. Recommendations for the implementation of telemedicine within stroke systems of care: a policy statement from the American Heart Association. Stroke 2009; 40: 2635-2660.
• 17 Shafqat S. 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 Specialists On Call (SOC). www.specialistsoncall.com (Download vom 11.04.2010).
• 19 Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 2007; 04: CD000197.
• 20 Vahedi K. et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007; 06: 215-222.
• 21 Wang DZ. Telemedicine: the solution to provide rural stroke coverage and the answer to the shortage of stroke neurologists and radiologists. Stroke 2003; 34: 2957.
• 22 Wang S. et al. Remote evaluation of acute ischemic stroke: reliability of National Institutes of Health Stroke Scale via telestroke. Stroke 2003; 34: e188-e191.
• 23 Wardlaw JM. et al. Thrombolysis for acute ischemic stroke. Cochrane Database Syst Rev 2009; 04: CD000213.
• 24 Wiborg A. et al. Beitrag der Telemedizin zur flächendeckenden Schlaganfallversorgung in ländlichen Gebieten. Akt Neurol 2000; 27: 119-124.