Search

Background: Patients with a large vessel occlusion require a transfer from a primary stroke centre to access thrombectomy, often over significant distances in regional areas. We sought to optimise stroke care access in the regional South Australian Tele-Strokeservice (SATS) to improve patient access to thrombectomy. Methods: We undertook a 24-month interventional historically controlled cohort study comparing acute stroke care metrics in the SATS. This consisted of a 12-month control period and a 12-month intervention monitoring period. The study intervention considered of an education package provided to the regional hospitals, a stroke neurologist roster to receive consultations and the intervention of a centralised tele-stroke system to provide treatment advice and organise patient transfers where needed. The SATS services 61 rural hospitals in South Australia, and Alice Springs in the Northern Territory. Suspected acute stroke patients presenting to the participating regional hospitals in SATS network where a telehealth consultation took place. Results: Over the study period, there were 919 patient referrals, with 449 consultations in the pre-intervention phase and 470 in the post-intervention phase. Demographic features in both epochs were similar. The post-intervention phase was associated with shorter door-to-scan time (35 min, IQR: 18,70; vs. 49 min, IQR:25,102, p < 0.0001), faster door-to-thrombolysis time (58 min, IQR: 39,91, vs.83 min, IQR: 55,100, p = 0.0324) and a higher portion of patients treated with thrombectomy (54, 11.5% vs. 26, 5.8%, p = 0.002). Conclusion: An optimised implementation of a streamlined telehealth platform with ongoing education and feedback to referring sites was associated with improved stroke workflow metrics and higher thrombectomy rates. [ABSTRACT FROM AUTHOR]

Introduction: Stroke in Regional Australia may have worse outcomes due to difficulties accessing optimal care. The South Australian Regional Telestroke service aimed to improve telestroke neurologist access, supported by improved ambulance triage. Objective: To assess stroke care quality and patient mortality pre‐ and postimplementation of a vascular neurologist‐led Telestroke service. Design: Historically controlled mixed methods cohort study comparing key quality indicators and patient mortality (6 months pre‐ vs. 18 months postimplementation date [4 June 2018]) at the three major South Australian regional stroke centres. The primary outcome was 13 care quality indicators as a combined composite risk‐adjusted score, and the secondary outcome was risk‐adjusted mortality at 12‐month postadmission. Findings: On an annualised basis, of 189 patients with stroke, more were admitted postintervention to the regional stroke centres than in the control period (158 [annualised rate 105.3, 95% CI 86.2–127.4] vs. 31 [annualised rate 62.0, 95% CI 47.5–79.5]) Baseline patient characteristics were similar in both periods. Post‐implementation, median last‐known‐well time to presentation (3.5 h [IQR 1.6–17] vs. 2.0 [IQR 1–14]; p = 0.46) and door to needle times (121 min [IQR 97–144] vs. 90 [IQR 75–138]; p = 0.65) were not significantly lower but an improvement in the combined composite quality score was observed (0.069 [95% CI 0.004–0.134; p = 0.04]), reflecting individual improvements in some quality indicators. Mortality at 12‐month postimplementation was substantially lower postimplementation (prechange 23% vs. postchange 13% [hazard ratio 0.58 (95% CI 0.44–0.76; p < 0.001)]). Conclusion: Implementation of a South Australian Regional Telestroke service was associated with improved care metrics and lower mortality. [ABSTRACT FROM AUTHOR]

• Paediatric patients with ALL are at an increased risk of stroke. • Patients with ALL will often have contraindications to thrombolysis. • EVT should be considered in paediatric ALL patients with acute ischaemic stroke. • Review of local stroke protocols at paediatric oncology centres may be warranted. Optimal treatment for ischaemic stroke in paediatric acute lymphoblastic leukaemia (ALL) is unclear. We describe an ischaemic stroke in an adolescent with ALL who underwent successful endovascular thrombectomy following leukaemic arterial occlusion. Endovascular thrombectomy should be considered in paediatric ALL patients with acute ischaemic stroke and large vessel occlusion. [ABSTRACT FROM AUTHOR]