Are hospital patients with stroke 'hiding in plain sight?'

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We're all told: Time is brain. And in a recent posting, even the newly developed tools to battle strokes work better when there's no delay.

So, it's a little distressing to find that time is still a problem - for patients who are already in a hospital. Even delays in imaging to determine best treatment. You'd think if the patient was already in the hospital, that would not be a problem.

But it is.

Read about recent research showing that imaging is delayed when a stroke strikes within a hospital:

Better speed to stroke treatment

More evidence that mobile stroke treatment can result in better outcomes. Just read about a recent study indicating that a mobile unit speeds access to tPA:

Nearly one-third of (32.6%) ischemic stroke patients who were transported in the special ambulance received thrombolysis, compared with 22% of patients who received conventional care ..., reported researcher Martin Ebinger, MD, of the Charite-Universitatsmedizin in Berlin, and colleagues.

Hospital transport ... increased the number of tissue plasminogen activator (tPA) treatments within the critical window of 1 hour (the "golden hour") from symptom onset almost 10-fold, they wrote online in JAMA Neurology.

Golden-hour thrombolysis was associated with better short-term outcomes in the study population, they added.

Read the whole article for details for a way to improve the application of this treatment and improved versions in the future.

It's global: Telemedicine can make a difference

Telemedicine is important in rural America. I've been through lots of small towns with few or no specialists who can make the difference between proper treatment and permanent disability or death.

Now, a study in Germany shows the impact telemedicine in that country:

During the same interval, the proportion of patients receiving thrombolytic therapy rose from 2.6% to 15.5%.

"The main findings of 10-year experience of TEMPiS showed that this type of telemedical stroke unit network is sustaining, offers state-of-the-art acute stroke care by increasing access to stroke units and improving thrombolysis service, and is associated with long-term improvement in terms of quality indicators of acute hospital care," Muller-Barna and colleagues wrote.

Telemedicine -- the use of modern teleconferencing technology to evaluate patients remotely and to recommend treatment strategies -- has increasingly been adopted in developed countries as a way to bring specialist care to rural areas where it is otherwise scarce or unavailable.

In the stroke setting, it involves putting stroke neurologists located mainly in urban tertiary care centers on call to evaluate patients brought into community hospitals in distant towns.

Time, as mentioned in this blog before, is key in stroke response. Using the combination of technology and medicine can decrease that time and improve outcomes.

Troubling age, race research results

I recently saw this troubling article from MedPage, from the annual meeting of the American Academy of Neurology. According to a study, age, race biases are seen in stroke transfers:

Blacks and the elderly were dramatically underrepresented among ischemic stroke patients in rural Alabama sent to a tertiary stroke center after initial thrombolysis, a researcher said here.

Compared with 212 patients presenting directly at the stroke center's emergency department, the 96 "drip-and-ship" patients were significantly younger (median age 63 versus 68, P=0.001) and less likely to be African American (21% versus 38%, P=0.012), said Amelia Boehme, MSPH, of the University of Alabama at Birmingham (UAB). ...

The drip-and-ship model is a method to deliver thrombolysis to acute stroke patients in facilities that lack onsite neurology coverage, the authors explained.

Again, these results are troubling. I realize that each case must be handled individually, but at the same time, every patient should expect quality care.