Inter-Hospital Transfer to a Vascular Neurology Unit After Telethrombolysis

Stroke is a major health problem with increasing incidence. It represents the leading cause of disability and the third cause of death in France. There are two main types of stroke: ischemic (80%) or hemorrhagic (20%).

Early thrombolysis is essential in treating ischemic strokes. The time window for thrombolysis is limited to 4,5 hours after symptoms onset.

In the French region of Franche Comté, in order to reduce the thrombolytic delay, a telemedicine network was developed between the neurovascular reference unit (NVU) localised in the University Hospital of Besançon and the peripheral hospital centres. Patients may then be transported to the NVU immediately after the thrombolysis initiation.

The aim of our study was to assess the relevance of a systematic medicalization of transfer to the NVU of patients with stroke who were telethrombolyzed before.

It was a retrospective, monocentric and observational study conducted over 24 months, in Franche-Comte (France). Evaluation of neurological status was made with the Glasgow score (GCS) and National Institute of Health Stroke Score (NIHSS). The respiratory (SpO2; needs O2) and hemodynamic status (arterial blood pressure, heart rate) were assessed as well as the need for medical resuscitation at different times of the transport (thrombolysis, transfer, arrival at the Regional University Hospital Centre).

Inclusion criteria

• Patient with ischaemic stroke
• Emergency department admission between 01/01/2012 and 12/31/2013
• Telemedicine stroke consult
• Thrombolysis therapy
• Patient transfered to NVU after thrombolysis initiation
• Transfer staffed by a qualified physician

Exclusion criteria

• Transfer non staffed by a qualified physician