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Master Thesis

Retentissement de la téléthrombolyse dans la prise en charge des accidents vasculaires cérébraux ischemiques sur le territoire du centre hospitalier intercommunal de Marmande-Tonneins

Abstract : Context: stroke is a frequent disease which can induce serious aftereffects and mortality. Thrombolysis is an efficient treatment in acute ischemic stroke if provided within 4.30 hours after first symptoms. For these reasons, a tele-thrombolysis network was created in January 2015 at the intercommunal hospital of Marmande Tonneins (IHMT), peripheric hospital located at 45 minutes of closest neuro-vascular units. Purpose: the purpose of the study was to evaluate the evolution of practices concerning the management of stroke in IHMT’s emergencies after the setting up of the tele-thrombolysis network. Methods: it was a descriptive study conducted between January 2013 to December 2016, before and after the implementation of the tele-thrombolysis network at IHMT’s emergency room. Patients living in the IHMT’s sector were included if diagnostic of ischemic or hemorrhagic stroke was retained after the emergency assessment. Other neurological diagnostics were excluded. The data has been transmitted to the Aquitaine Observatory of stroke to compare different indicators of clinical performance between the two periods. Results: of the 857 patients included in the study, 527 were treated at IHMT and 330 at Agen Hospital between 2013 and 2016. The NIH score rate in IHMT decreased slightly over the two periods (61.4% vs. 57.3%, p = 0.32). First-line MRI increased from 6.3% to 15.7% (p = 0.001). 37 patients were thrombolysed at IHMT between 2015 and 2016 against 26 at Agen Hospital over the same period. The rate of patients (IHMT’s sector) thrombolysed in IHMT or Agen Hopsital increased from 7.6% to 14.6% of suspicions of stroke in the IHMT’s territory (p = 0.001). The median time from onset of symptoms to thrombolysis was 3:00 in IHMT against 3:30 in Agen Hospital in 2015-2016 for suspected stroke patients in the territory of IHMT. Discussion: the study found that most of the indicators of good practice were experiencing a satisfactory evolution in both periods. It can therefore be concluded that the implementation of tele-thrombolysis in IHMT emergencies is satisfactory. The organization of the AVC sector will have to adapt with the emergence of thrombectomy extended to many patients with ischemic stroke in the future.
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Master Thesis
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Clément Julhes. Retentissement de la téléthrombolyse dans la prise en charge des accidents vasculaires cérébraux ischemiques sur le territoire du centre hospitalier intercommunal de Marmande-Tonneins. Médecine humaine et pathologie. 2017. ⟨dumas-01676436⟩

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