Telemedizin in der akuten Schlaganfallversorgung

 

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Zusammenfassung

Telemedizinische Anwendungen mit klinischer Untersuchung des Patienten über Videokonferenz und Fernbefundung der zerebralen Schnittbildgebung haben verbreitete Nutzung in der akuten Schlaganfallversorgung insbesondere in Regionen mit unzureichenden neurologischen Behandlungseinrichtungen gefunden. Wissenschaftliche Untersuchungen haben die Zuverlässigkeit der neurologischen Fernuntersuchung bestätigt und die Indikation für die systemische Lysetherapie kann über Telekonsile mit entsprechenden technischen Qualitätsstandards sicher gestellt werden. Eine Verbesserung klinischer Behandlungsergebnisse konnte bisher aber nur gezeigt werden, wenn die Telemedizin in das Konzept der Stroke Unit mit spezialisierten Schlaganfalleinheiten und entsprechenden Qualitätsstandards eingebettet wurde. Außerhalb eines derartigen integrierten Konzeptes ist ein klinisches Benefit nicht nachgewiesen. Forschungsbedarf besteht im Bereich der Kosteneffizienz, des Qualitätsmanagements und der Implementierung weiterer technologischer Innovationen. Der Einsatz der Telemedizin in der Prävention, prähospitalen Schlaganfallversorgung, Rehabilitation und ambulanten Nachsorge ist nicht ausreichend untersucht und bedarf einer konsequenten wissenschaftlichen Evaluation.

Abstract

Telemedicine is increasingly being utilised for the remote evaluation of stroke patients, particularly in neurologically underserved areas. It is usually based on video examination and teleradiological evaluations of brain scans. Scientific analyses have demonstrated the reliability of neurological scores assessed via videoconference. Teleradiology using electronically transmitted original imaging data is potentially equivalent to onsite assessment. Intravenous thrombolysis can be indicated with similar results as in experienced stroke centres if both technological and professional quality standards are applied. However, improved clinical outcomes of stroke patients have only been shown when telemedicine was combined with the Stroke Unit concept based on specialised stroke wards and organised stroke care. More scientific evaluation is needed in the fields of cost effectiveness, quality management and implementation of further technological innovations. There are still insufficient data about the use of telemedicine in prevention, rehabilitation and post-stroke care and a comprehensive scientific evaluation is still needed.

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PD Dr. med. Heinrich J. Audebert

Klinik für Neurologie und klinische Neurophysiologie, Charité, Universitätsmedizin Berlin

Hindenburgdamm 30

12200 Berlin

Email: heinrich.audebert@charite.de