Drip-and-Ship Thrombolytic Therapy Supported by the Telestroke System for Acute Ischemic Stroke Patients Living in Medically Under-served Areas

Kageji, Teruyoshi; Obata, Fumiaki; Oka, Hiroyuki; Kanematsu, Yasuhisa; Tabata, Ryo; Tani, Kenji; Bando, Hiroyasu; Saijo, Nagahiro

doi:10.2176/nmc.oa.2016-0100

Cited by 15 publications

(13 citation statements)

References 25 publications

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“…11,12) Kageji et al reported the development of a telestroke system in which a general internist begins intravenous thrombolysis with rt-PA therapy at a primary care facility under the guidance of a specialist at a hub stroke center using the Synapse ERm application before the patient is transferred to the stroke center. 11) In conducting such drip-and-ship treatment for acute cerebral infarction via such a telestroke system, it has been suggested that the stay in the primary care facility that conducts intravenous thrombolysis with rt-PA (doorin-to-door-out time [DIDO]) is prolonged, resulting in prolongation of the time from onset to recanalization (onset-to-recanalization time [O2R]). [12][13][14][15] McTaggart et al 14) reported that DIDO was able to be shortened by education of the primary care facility and sharing of images through a cloud service, but Froehler et al 13) reported by a prospective observational study 984 cases in which the O2R was significantly prolonged with deterioration of the outcome in patients transferred from other hospitals compared with those directly transported to the hospital.…”

Section: Discussionmentioning

confidence: 99%

Practical Use of a Communication Application on Mobile Devices by Our Stroke Team

Tokunaga

Inoue

Suruga

et al. 2020

JNET

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To describe our 1-year experience of the practical use of a mobile communication application by our stroke team. Methods: The mobile Join application (Allm Inc., Tokyo, Japan) was introduced into our stroke team for the purpose of immediate sharing of the patient information. We analyzed the usage situation for 1 year after the introduction of Join, particularly its efficacy in improving the door-to-puncture time (D2P) for thrombectomy cases, and reported our interhospital collaboration with the use of Join. Results: The total number of events notified by Join was 337, and they included acute stroke potentially leading to reperfusion therapy in 23% (76 events), head trauma in 14%, brain hemorrhage in 12%, other infarction in 10%, subarachnoid hemorrhage in 8%, and the others in 34%. The information of the patients was shared among the team members before arrival to our hospital in 42% of acute stroke cases. Of 31 patients undergoing mechanical thrombectomy, the median interval between arrival and groin puncture for the directly transported patients with/without pre-hospital information was 77.5 min/87 min, respectively, whereas that of the patients transferred from primary hospitals with/without pre-hospital information was 19 min/71 min (p <0.0001), respectively, demonstrating the efficacy of information sharing in advance through Join in improving the timing of endovascular therapy. For inter-hospital collaboration using the telestroke system, we concluded the partnership agreement with three local primary hospitals by communication via Join at a reasonable cost. Conclusion: Active and effective utilization of the mobile Join application for communication by our stroke team was demonstrated, and it is expected to promote inter-hospital collaboration in stroke treatment. Keywords▶ mechanical thrombectomy, medical informatics, mobile smartphone application, stroke team, telemedicine for the diagnosis and treatment of stroke, but there have been few reports on their actual state of utilization. Join (Allm Inc., Tokyo) is a communication application for medical workers approved by the pharmaceutical affairs regulatory authorities as a program for generalpurpose diagnostic imaging, the security of which is guaranteed by conforming to guidelines proposed by related ministries and agencies. 1) Join makes it possible to have chats within a team using mobile devices and view anonymized DICOM images in the hospital PACS, as well as to share information with other facilities that have adopted Join via a special server. In April 2018, our hospital was the first in the prefecture to install Join for prompt sharing of information among members of the Brain Disease Center, consisting of neurosurgeons and neurologists, and initiation of treatment, relieving the burden on on-call doctors in the stroke care unit, in addition to consultation with orthopedists/radiologists on standby outside the hospital from This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Section: Discussionmentioning

confidence: 99%

Practical Use of a Communication Application on Mobile Devices by Our Stroke Team

Tokunaga

Inoue

Suruga

et al. 2020

JNET

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“…Several previous studies have compared patients treated on arrival at a primary emergency department with patients treated using the DS paradigm. 13–16) The DS method is currently used for one in four patients treated with IV rt-PA in the United States (US). 8) The present study is unique for its focus on the comparison between patients with treatment initiated on remote islands and those treated on the mainland.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the Drip and Ship Method in 24-h Helicopter Transportation and Teleradiology for Isolated Islands

Hiu

Ozono

Kawahara

et al. 2019

Neurol. Med. Chir.(Tokyo)

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Our hospital, located on the mainland, serves as a hub center for nine hospitals on the remote islands of Nagasaki Prefecture, Japan. There are no stroke specialists on these islands. We can transfer emergency patients from these islands to our hospital at any time, using a teleradiology system and three types of helicopter transport. We examined the efficacy of the drip and ship (DS) method for treating patients with acute ischemic stroke (AIS) on these islands, in comparison with patients on the mainland. From 2010 to 2017, we reviewed 98 consecutive patients with AIS who received intravenous recombinant tissue plasminogen activator (IV rt-PA) in our hospital or were transported to our hospital after IV rt-PA. Patients were divided into the Islands group (received IV rt-PA on the islands, DS; 31 cases) and the Mainland group (67 cases). The median transport distance from the islands was 112 km. The rate of patients achieving favorable outcomes was 54.8% in the Islands group and 64.2% in the Mainland group, with no significant differences. Multivariate analysis revealed that patients living on isolated islands did not have increased risks of unfavorable outcomes. Endovascular therapy (EVT), as part of the drip, ship, and retrieve method, was performed in 22.6% of patients in the Islands group and EVT in 38.8% of those in the Mainland group. The DS method seems feasible and safe for patients living on isolated islands with the use of 24-h helicopter transportation and teleradiology.

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“…In a community in the absence of acute stroke physicians who are specialized in the present guidelines or in a medical institution where there is a time period with an absence of full-time stroke physicians, remote stroke treatment (telestroke) may enable IV thrombolysis safely even in the absence of the stroke physicians in the clinical setting and is admissible as a system for remote locations. 63–66) In addition, for neurosurgical procedures, if a system is established so that a prompt response can be made within at least 2 h by neurosurgeons, a response could be also made by the transportation of patients to other hospitals or on-call neurosurgeons. A prompt response made within 2 h is only defined as a consensus-based value, and it is desirable to have a system where a response can be made as soon as possible.…”

Section: Required Elements For Medical Institutionsmentioning

confidence: 99%

Guidelines for Intravenous Thrombolysis (Recombinant Tissue-type Plasminogen Activator), the Third Edition, March 2019: A Guideline from the Japan Stroke Society

Toyoda

Koga

Iguchi

et al. 2019

Neurol. Med. Chir.(Tokyo)

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Drip-and-Ship Thrombolytic Therapy Supported by the Telestroke System for Acute Ischemic Stroke Patients Living in Medically Under-served Areas

Cited by 15 publications

References 25 publications

Practical Use of a Communication Application on Mobile Devices by Our Stroke Team

Practical Use of a Communication Application on Mobile Devices by Our Stroke Team

Efficacy of the Drip and Ship Method in 24-h Helicopter Transportation and Teleradiology for Isolated Islands

Guidelines for Intravenous Thrombolysis (Recombinant Tissue-type Plasminogen Activator), the Third Edition, March 2019: A Guideline from the Japan Stroke Society

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