TY  - JOUR
A1  - Barlinn, J.
A1  - Winzer, S.
A1  - Worthmann, H.
A1  - Urbanek, C.
A1  - Häusler, K. G.
A1  - Günther, A.
A1  - Erdur, H.
A1  - Görtler, M.
A1  - Busetto, L.
A1  - Wojciechowski, C.
A1  - Schmitt, J.
A1  - Shah, Y.
A1  - Büchele, B.
A1  - Sokolowski, P.
A1  - Kraya, T.
A1  - Merkelbach, S.
A1  - Rosengarten, B.
A1  - Stangenberg-Gliss, K.
A1  - Weber, J.
A1  - Schlachetzki, F.
A1  - Abu-Mugheisib, M.
A1  - Petersen, M.
A1  - Schwartz, A.
A1  - Palm, F.
A1  - Jowaed, A.
A1  - Volbers, B.
A1  - Zickler, P.
A1  - Remi, J.
A1  - Bardutzky, J.
A1  - Bösel, J.
A1  - Audebert, H. J.
A1  - Hubert, G. J.
A1  - Gumbinger, C.
T1  - Telemedizin in der Schlaganfallversorgung – versorgungsrelevant für Deutschland
T1  - Telemedicine in stroke—pertinent to stroke care in Germany
JF  - Der Nervenarzt
N2  - Hintergrund und Ziel
Telemedizinische Schlaganfall-Netzwerke tragen dazu bei, die Schlaganfallversorgung und insbesondere den Zugang zu zeitkritischen Schlaganfalltherapien in vorrangig strukturschwachen, ländlichen Regionen zu gewährleisten. Ziel ist eine Darstellung der Nutzungsfrequenz und regionalen Verteilung dieser Versorgungsstruktur.

Methoden
Die Kommission „Telemedizinische Schlaganfallversorgung“ der Deutschen Schlaganfall-Gesellschaft führte eine Umfragestudie in allen Schlaganfall-Netzwerken durch.

Ergebnisse
In Deutschland sind 22 telemedizinische Schlaganfall-Netzwerke aktiv, welche insgesamt 43 Zentren (pro Netzwerk: Median 1,5, Interquartilsabstand [IQA] 1–3) sowie 225 Kooperationskliniken (pro Netzwerk: Median 9, IQA 4–17) umfassen und an einem unmittelbaren Zugang zur Schlaganfallversorgung für 48 Mio. Menschen teilhaben. Im Jahr 2018 wurden 38.211 Telekonsile (pro Netzwerk: Median 1340, IQA 319–2758) durchgeführt. Die Thrombolyserate betrug 14,1 % (95 %-Konfidenzintervall 13,6–14,7 %), eine Verlegung zur Thrombektomie wurde bei 7,9 % (95 %-Konfidenzintervall 7,5–8,4 %) der ischämischen Schlaganfallpatienten initiiert. Das Finanzierungssystem ist uneinheitlich mit einem Vergütungssystem für die Zentrumsleistungen in nur drei Bundesländern.

Diskussion
Etwa jeder 10. Schlaganfallpatient wird telemedizinisch behandelt. Die telemedizinischen Schlaganfall-Netzwerke erreichen vergleichbar hohe Lyseraten und Verlegungen zur Thrombektomie wie neurologische Stroke-Units und tragen zur Sicherstellung einer flächendeckenden Schlaganfallversorgung bei. Eine netzwerkübergreifende Sicherstellung der Finanzierung und einheitliche Erhebung von Qualitätssicherungsdaten haben das Potenzial diese Versorgungsstruktur zukünftig weiter zu stärken.
N2  - Background and objective
Telemedical stroke networks improve stroke care and provide access to time-dependent acute stroke treatment in predominantly rural regions. The aim is a presentation of data on its utility and regional distribution.

Methods
The working group on telemedical stroke care of the German Stroke Society performed a survey study among all telestroke networks.

Results
Currently, 22 telemedical stroke networks including 43 centers (per network: median 1.5, interquartile range, IQR, 1–3) as well as 225 cooperating hospitals (per network: median 9, IQR 4–17) operate in Germany and contribute to acute stroke care delivery to 48 million people. In 2018, 38,211 teleconsultations (per network: median 1340, IQR 319–2758) were performed. The thrombolysis rate was 14.1% (95% confidence interval 13.6–14.7%) and transfer for thrombectomy was initiated in 7.9% (95% confidence interval 7.5–8.4%) of ischemic stroke patients. Financial reimbursement differs regionally with compensation for telemedical stroke care in only three federal states.

Conclusion
Telemedical stroke care is utilized in about 1 out of 10 stroke patients in Germany. Telemedical stroke networks achieve similar rates of thrombolysis and transfer for thrombectomy compared with neurological stroke units and contribute to stroke care in rural regions. Standardization of network structures, financial assurance and uniform quality measurements may further strengthen the importance of telestroke networks in the future.
KW  - Schlaganfall
KW  - Stroke-Unit
KW  - Telemedizin
KW  - Schlaganfall-Netzwerk
KW  - Umfragestudie
KW  - stroke
KW  - stroke unit
KW  - telemedicine
KW  - stroke networks
KW  - survey
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-307752
SN  - 0028-2804
SN  - 1433-0407
VL  - 92
IS  - 6
ER  - 
TY  - JOUR
A1  - Kraft, Peter
A1  - Fleischer, Anna
A1  - Wiedmann, Silke
A1  - Rücker, Viktoria
A1  - Mackenrodt, Daniel
A1  - Morbach, Caroline
A1  - Malzahn, Uwe
A1  - Kleinschnitz, Christoph
A1  - Störk, Stefan
A1  - Heuschmann, Peter U.
T1  - Feasibility and diagnostic accuracy of point-of-care handheld echocardiography in acute ischemic stroke patients - a pilot study
JF  - BMC Neurology
N2  - Background:
Standard echocardiography (SE) is an essential part of the routine diagnostic work-up after ischemic stroke (IS) and also serves for research purposes. However, access to SE is often limited. We aimed to assess feasibility and accuracy of point-of-care (POC) echocardiography in a stroke unit (SU) setting.

Methods:
IS patients were recruited on the SU of the University Hospital Würzburg, Germany. Two SU team members were trained in POC echocardiography for a three-month period to assess a set of predefined cardiac parameters including left ventricular ejection fraction (LVEF). Diagnostic agreement was assessed by comparing POC with SE executed by an expert sonographer, and intraclass correlation coefficient (ICC) or kappa (κ) with 95% confidence intervals (95% CI) were calculated.

Results:
In the 78 patients receiving both POC and SE agreement for cardiac parameters was good, with ICC varying from 0.82 (95% CI 0.71–0.89) to 0.93 (95% CI 0.87–0.96), and κ from 0.39 (−95% CI 0.14–0.92) to 0.79 (95% CI 0.67–0.91). Detection of systolic dysfunction with POC echocardiography compared to SE was very good, with an area under the curve of 0.99 (0.96–1.00). Interrater agreement for LVEF measured by POC echocardiography was good with κ 0.63 (95% CI 0.40–0.85).

Conclusions:
POC echocardiography in a SU setting is feasible enabling reliable quantification of LVEF and preliminary assessment of selected cardiac parameters that might be used for research purposes. Its potential clinical utility in triaging stroke patients who should undergo or do not necessarily require SE needs to be investigated in larger prospective diagnostic studies.
KW  - ischemic stroke
KW  - systolic dysfunction
KW  - point-of-care echocardiography
KW  - ejection fraction
KW  - stroke unit
KW  - feasibility
KW  - accuracy
Y1  - 2017
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-158081
VL  - 17
IS  - 159
ER  -