2018 Volume 40 Issue 2 Pages 112-116
Purpose: There are only few stroke specialists in the medically under-served areas of Japan. To correct the specialist shortage in a medically under-served area located in Tokushima Prefecture, the Department of Regional Neurosurgery was established in the Tokushima Prefectural Kaifu Hospital in October 2011. Additionally, a mobile telestroke support system that accesses the internet via a smartphone was introduced in February 2013. We analyzed the effect of the new support system on acute stroke in the medically under-served area of Tokushima. Methods: Acute stroke patients treated in Kaifu Hospital were divided into two groups. Group A comprised 253 patients treated from October 2011 to December 2014, after the introduction of the new support system. Group B comprised 103 patients treated from October 2009 to September 2010, before the introduction of the new support system. We analyzed the time interval from the patient’s home to the start of the treatment, the rate of admission to the hospital for further treatment, and the patient outcome. Results: The average time taken from the patient’s home to the start of the treatment for stroke in Groups A and B were 30 min and 100 min, respectively, with a significant statistical difference (p=0.0068). The admission rate for further treatment decreased significantly in Group A than in Group B (p<0.001). The improvement in the average value of modified Rankin scale at discharge was significantly higher in Group A than in Group B (p<0.0001). We implemented intravenous recombinant tissue plasminogen activator infusion therapy using a drip-and-ship protocol in Kaifu Hospital in 8.6% of patients with acute ischemic stroke after the introduction of the new support system. The telestroke system was used in 50% of the acute stroke patients, and 87% of it was used in off-time period. Conclusion: The new support system for acute stroke in the medically under-served area of Tokushima involves direct medical treatment by a stroke specialist during office hours and indirect specialist support to general physicians using the telestroke system during overtime, night, and holiday work. We observed that the new system could reduce the time interval to start the treatment and contribute to the improvement of patients’ outcome.
