Development of a prehospital stroke hotline system on remote islands

DOI Web Site 3 References Open Access
  • Otsuka Hiroaki
    Department of Internal Medicine, Nagasaki Hospital Agency, Nagasaki Prefecture Tsushima Hospital
  • Hiu Takeshi
    Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center
  • Ae Ryusuke
    Department of Public Health, Jichi Medical University
  • Yoshimura Shota
    Department of Internal Medicine, Nagasaki Hospital Agency, Nagasaki Prefecture Tsushima Hospital
  • Iwanaga Hiroshi
    Department of Neurology, National Hospital Organization Nagasaki Medical Center
  • Nakamichi Chikaaki
    Department of Emergency, National Hospital Organization Nagasaki Medical Center
  • Yasaka Takahiro
    Department of Internal Medicine, Nagasaki Hospital Agency, Nagasaki Prefecture Tsushima Hospital
  • Tsutsumi Keisuke
    Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center

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  • 脳卒中非専門内科医が初動する長崎県離島施設前脳卒中ホットラインシステム（I-SHOT）の構築 ─本土急性期基幹病院と連携した診療・搬送システムの試み─

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Abstract

<p>Background and Purpose: To treat cases of acute stroke on remote islands where there are no stroke specialists, we established a stroke hotline (the Isolated Islands Stroke Hotline system: I-SHOT) in collaboration with an acute care hub center on the mainland. We investigated whether implementation of I-SHOT contributes to an increase in the number of patients treated with intravenous rt-PA using the drip and ship (DS) method. Methods: We compared the number of DS cases, patient background, door to needle (DTN) time, prognosis, and complications before (early period: 2012–16) and after (late period: 2017–19) implementation of I-SHOT. Results: After the introduction of I-SHOT, there was a significant increase in the number of DS cases (early period: 3/197 cases [1.5%] vs. late period: 16/125 cases [12.8%], respectively; p<0.01); there was a decrease in DTN time from before to after the introduction of ISHOT (mean 118 minutes vs. 80 minutes). Two patients (67%) in the early period versus 9 (56%) in the late period achieved favorable outcomes (modified Rankin Scale score at 90 days ≤2). Conclusions: The introduction of I-SHOT led to an increase in the number of DS cases by allowing medical institutions on remote islands in Japan that are staffed exclusively by non-stroke specialists to collaborate with the acute care hub center on the mainland.</p>

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