Telestroke en Chile: resultados de 1 año de experiencia de la Unidad de TeleACV del Servicio de Salud Metropolitano Sur en 7 hospitales ejecutores

Mansilla, Eloy; Mazzon, Enrico; Cárcamo, Daniel; Jurado, Felipe; Lara, Lorena; Arévalo, Mirya; Rojas, Diego; Stephens, G.Everett; Hoppe, Arnold; Brunser, Alejandro M.

doi:10.4067/s0034-98872019000901107

Cited by 8 publications

(8 citation statements)

References 14 publications

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“…Usually, these patients benefit from the teleneurology program when they cannot attend the hospital for followup after discharge from HHT. Therefore, in our opinion, the implementation of similar teleneurology programs could be aimed at controlling the burden of ambulatory disease, and a different program might be required for the treatment of stroke in an emergency context, depending on the availability of health system resources, as previously described in Chile (10) and globally (25).…”

Section: Discussionmentioning

confidence: 98%

“…The shortage of medical specialists has exacerbated the country's geographical difficulties in delivering tertiary healthcare; however, this situation provides an opportunity for telemedicine to improve patient access to professional medical services. Therefore, the implementation and the development of telemedicine in the Chilean public healthcare system is a good means of overcoming the shortage of experts and the transportation problems for ambulatory patients (9) and acute stroke patients (10).…”

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confidence: 99%

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Characterization of the Teleneurology Patients at the Hospital Las Higueras de Talcahuano—Chile

et al. 2020

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Background: Chile has a shortage of medical experts, including neurologists. The remote neurology program at Las Higueras Hospital in Talcahuano (HHT) was implemented in 2015 to decrease the number of patients waiting for their first appointment.Methods: This retrospective study analyzed a cohort of 2,904 ambulatory patients evaluated in the teleneurology program at the HHT between 2015 and 2019 who were referred from 16 primary and 3 tertiary healthcare centers.Results: Out of the 2,904 patients included in the study, 1,020 patients (35%) were male, and 1,884 (65%) were female. In total, 1,346 (46.0%) patients were under 60 years old (408 male and 938 female), and 1,558 (54%) were over 60 years old (612 male and 946 female). The patients were referred to a neurologist in the teleneurology program from different primary healthcare centers (93.5%) and tertiary healthcare centers (6.5%). The most common diseases diagnosed through teleneurology were, in decreasing order, headache (29.4%), Alzheimer's disease and other dementias (15.9%), and epilepsy (11.4%). From July 2018, we analyzed the patients' destination after the first teleneurology consultation. In the cohort of 634 patients who had their first consultation via the teleneurology program, 547 (86.3%) were instructed to continue follow-up via telemedicine.Conclusions: Data from this study show, for the first time in Chile, the significant contribution of the teleneurology program at the HHT to the diagnosis of a broad range of diseases in a substantial number of patients referred from primary and tertiary healthcare centers.

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

Characterization of the Teleneurology Patients at the Hospital Las Higueras de Talcahuano—Chile

et al. 2020

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“…La estrategia Drip and Ship ha demostrado su eficacia en diferentes estudios. 9,10 En la revisión narrativa de la literatura no encontramos reportes de trombolisis en centro primario y remisión a trombectomía en Colombia, sin embargo, usando datos de retroalimentación del registro RES-Q solamente se registró "drip and ship" en el 0.32% de los casos en nuestro país. En Latinoamérica se ha reportado su práctica en Chile en el registro de un programa de tele-trombolisis donde se remitió al 7% de los pacientes que recibieron trombolisis para TM.…”

Section: Discussionunclassified

“…En Latinoamérica se ha reportado su práctica en Chile en el registro de un programa de tele-trombolisis donde se remitió al 7% de los pacientes que recibieron trombolisis para TM. 10 En Brasil un estudio que incluyó 300 pacientes, estudió la eficacia de la trombectomía en 12 hospitales públicos en pacientes con oclusión intracraneal proximal de la circulación anterior que podía tratarse dentro de las 8 horas del inicio de los síntomas, se aleatorizaron en razón 1:1 para recibir manejo estándar con alteplasa vs manejo estándar versus TM y se midieron los desenlaces con la mRS. De los 300 pacientes, aproximadamente el 70% recibió alteplasa en ambos grupos. El estudio se detuvo de manera prematura por eficacia temprana cuando 221 de 690 pacientes se aleatorizaron (111 al grupo de trombectomía y 110 al grupo control).…”

Section: Discussionunclassified

Drip and ship: Una práctica usual en el tratamiento de ictus isquémico por oclusión de arterias proximales en países de altos ingresos pero anecdótica en Colombia

Amaya¹,

Arango²,

Prado³

et al. 2022

revecuatneurol

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Resumen El Drip and Ship consiste en administrar trombolisis endovenosa en centro primario y remisión para trombectomía mecánica. Objetivo: Describir la experiencia Drip and Ship como intervención del ictus isquémico en dos regiones de Colombia. Métodos: Serie de casos retrospectiva de pacientes tratados con Drip and Ship durante 2019 y primer cuartil de 2021. Se compararon variables como puerta-imagen, puerta-aguja, puerta-ingle y desenlaces clínicos. Se calcularon medidas de tendencia central y estadísticas descriptivas. Resultados: Se registraron seis pacientes con ictus isquémico y oclusión proximal. Mediana de 60 minutos de inicio de síntomas, puerta-aguja 75 minutos, tiempo door-in door-out 167.5 minutos, tiempo de traslado 91.5 minutos para remisión desde otra ciudad. Cinco pacientes recibieron trombectomía mecánica con TICI 2c-3. 50% de los pacientes con Rankin modificado favorable al egreso y 84% a tres meses. Conclusiones: En el registro RES-Q entre 2019 y el primer cuartil de 2021, se consignaron 5954 casos de ictus isquémico en Colombia, 20 pacientes tratados con Drip and Ship (0,33%). Los tiempos de puerta- aguja y de remisión fueron mayores a lo recomendado en guías internacionales, siendo mayor en los pacientes provenientes de otras ciudades. Se requiere estructurar redes de atención para mejorar tiempos de tratamiento y número de pacientes tratados.

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“…The Santiago TS Unit was formed in 2017 [ 14 ] and is made up of seven hospitals around Chile connected to a virtual hub. When a patient arrives at the hospital with symptoms suggesting a stroke within 4 h of last known well, blood tests are taken, and a nonenhanced brain CT scan is done.…”

Section: Methodsmentioning

confidence: 99%

A Chilean Experience of Telestroke in a COVID-19 Pandemic Year

et al. 2022

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Background and Purpose: Telemedicine for stroke patients’ care (telestroke [TS]) has grown notably in recent decades and may offer advantages during health crisis. Hospital admissions related to stroke have decreased globally during the COVID-19 pandemic, but scarce information is available regarding the effect of COVID-19 in TS. Using a population-based TS registry, we investigated the impact of the first year of the COVID-19 pandemic throughout our TS network in Santiago, Chile. Methods: Stroke codes evaluated after the onset of COVID-19 restrictions in Chile (defined as March 15, 2020) were compared with those evaluated in 2019. We analyzed differences between number of stroke codes, thrombolysis rate, stroke severity, and time from the stroke onset to hospital admission. Results: We observed that the number of stroke codes and the number of patients undergoing reperfusion therapy did not change significantly (p = 0.669 and 0.415, respectively). No differences were found with respect to the median time from the stroke onset to admission (p = 0.581) or in National Institutes of Health Stroke Scale (NIHSS) scores (p = 0.055). The decision-making-to-needle time was significantly shorter in the COVID-19 period (median 5 min [IQR 3–8], p < 0.016), but no significant changes were found at the other times. Conclusions: This study demonstrates the potential of adapting TS to extreme situations such as the COVID-19 pandemic, as well as the importance of establishing networks that facilitate patient access to quality treatments.

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Telestroke en Chile: resultados de 1 año de experiencia de la Unidad de TeleACV del Servicio de Salud Metropolitano Sur en 7 hospitales ejecutores

Cited by 8 publications

References 14 publications

Characterization of the Teleneurology Patients at the Hospital Las Higueras de Talcahuano—Chile

Characterization of the Teleneurology Patients at the Hospital Las Higueras de Talcahuano—Chile

Drip and ship: Una práctica usual en el tratamiento de ictus isquémico por oclusión de arterias proximales en países de altos ingresos pero anecdótica en Colombia

A Chilean Experience of Telestroke in a COVID-19 Pandemic Year

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