Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial

Walter, Silke; Kostopoulos, Panagiotis; Haaß, A.; Keller, Isabel; Lesmeister, Martin; Schlechtriemen, T.; Roth, Christian; Papanagiotou, Panagiotis; Grunwald, Iris Q.; Schumacher, Helmut; Helwig, Stephan; Viera, Julio; Körner, Heiko; Alexandrou, Maria Eleni; Yılmaz, Ümüt; Ziegler, Karin; Schmidt, Kathrin; Dabew, Rainer; Kubulus, Darius; Liu, Yang; Volk, Thomas; Kronfeld, Kai; Ruckes, Christian; Bertsch, Thomas; Reith, Wolfgang; Faßbender, Klaus

doi:10.1016/s1474-4422(12)70057-1

Cited by 415 publications

(365 citation statements)

References 33 publications

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“…Although the vast majority of telestroke studies relied on quasiexperimental designs, mostly by necessity, in 2012 a rare RCT, conducted in Germany, compared diagnosis and treatment of stroke patients in a mobile stroke unit versus in-hospital. 99 Randomization was by week, alternating between experimental and control groups, and was not masked from patients or investigators. The mobile units were equipped with a CT scanner, laboratory, and telemedicine equipment.…”

Section: The Search For Evidencementioning

confidence: 99%

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

Bashshur

Shannon

Smith

et al. 2014

Telemedicine and e-Health

274

210

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The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/readmissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.

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Section: The Search For Evidencementioning

confidence: 99%

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

Bashshur

Shannon

Smith

et al. 2014

Telemedicine and e-Health

274

210

View full text Add to dashboard Cite

show abstract

“…STEMO is set up to prove that this specific treatment can be safely administered in a prehospital setting and actually safes time compared to regular care 8,11 . First results from 12 prehospital thrombolyses in the Saarland State, Germany, seem promising in this respect 12 . In this study, Walter and colleagues reported that after randomized weeks between November, 2008, and July, 2011 and an interim analysis at 100 of 200 planned patients (53 in the prehospital setting, 47 in the control group), the median time from alarm to therapy decision (primary end-point) was substantially reduced in the 12 cases of prehospital thrombolysis: 35 min (IQR 31-39) versus 76 min, p<0.0001; median difference 41 min (95% CI 36-48 min).…”

Section: Discussionmentioning

confidence: 99%

Prehospital Thrombolysis: A Manual from Berlin

Ebinger¹,

Lindenlaub²,

Kunz³

et al. 2013

JoVE

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In acute ischemic stroke, time from symptom onset to intervention is a decisive prognostic factor. In order to reduce this time, prehospital thrombolysis at the emergency site would be preferable. However, apart from neurological expertise and laboratory investigations a computed tomography (CT) scan is necessary to exclude hemorrhagic stroke prior to thrombolysis. Therefore, a specialized ambulance equipped with a CT scanner and point-of-care laboratory was designed and constructed. Further, a new stroke identifying interview algorithm was developed and implemented in the Berlin emergency medical services. Since February 2011 the identification of suspected stroke in the dispatch center of the Berlin Fire Brigade prompts the deployment of this ambulance, a stroke emergency mobile (STEMO). On arrival, a neurologist, experienced in stroke care and with additional training in emergency medicine, takes a neurological examination. If stroke is suspected a CT scan excludes intracranial hemorrhage. The CT-scans are telemetrically transmitted to the neuroradiologist on-call. If coagulation status of the patient is normal and patient's medical history reveals no contraindication, prehospital thrombolysis is applied according to current guidelines (intravenous recombinant tissue plasminogen activator, iv rtPA, alteplase, Actilyse).Thereafter patients are transported to the nearest hospital with a certified stroke unit for further treatment and assessment of strokeaetiology. After a pilot-phase, weeks were randomized into blocks either with or without STEMO care. Primary end-point of this study is time from alarm to the initiation of thrombolysis. We hypothesized that alarm-to-treatment time can be reduced by at least 20 min compared to regular care.

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“…(Walter et al 2010, Ebinger et al 2013 The concept has proven to be successful in randomized controlled trials (Walter et al 2012, Ebinger et al 2014) and it has deemed as highly cost-effective solution in a large metropolitan setting. However, the concept requires a large and high costs (Gyrd-Hansen et al 2015).…”

Section: Dispatch Time <1 Minutementioning

confidence: 99%

Stroke and the emergency medical services – enhancing performance within the chain of survival

Puolakka

2017

Acta Anaesthesiol Scand

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Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial

Cited by 415 publications

References 33 publications

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

Prehospital Thrombolysis: A Manual from Berlin

Stroke and the emergency medical services – enhancing performance within the chain of survival

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