MODELLING STROKE NETWORKS WITH TELEMEDICINE IN 4 ITALIAN REGIONS

Background and Aims: The ESO Telestroke recommendations described criteria for Telestroke networks sustainability. Italy has large underpopulated areas with seasonal population variability and reduced stroke care. A group of experts selected in 4 Italian regions (Tuscany, Emilia-Romagna, Lazio, and Umbria) areas underserved in the local stroke networks. We suggested a coverage of these areas using a Telestroke Units (TSU) and or Telethrombolysis units (TTU) services according to the ESO recommendations. Methods: When choosing the right service for a telestroke network two rules should be applied: (1) the TSU should treat at least 200 stroke patients per year and (2) acute stroke care should be within reach of 45 min for 90% of the population. Minimum area size to be covered by a single stroke unit can be calculated by the Hubert formula. Size is inversely related to population density (population/km2) and stroke incidence (number of strokes/ 100.000/year). Transport times were calculated using google maps simulations. Results: Four different isolated areas were identified: Lunigiana, Valnerina, Reggio Emilia county, Latina coast. The population density was ranging between 69 and 254 people per sq/km with a stroke incidence of 0.0016. The area size range was 566–2256 sq/km. One area satisfied criteria 1 for TSU (Latina coast) and 3 others fulfilled criteria 2 for TTU (Reggio-Emilia county, Lunigiana, Valnerina). Conclusions: Access to thrombolysis may be further guaranteed by telemedicice coverage with appropriately deployed services. Modeling stroke care with telemedicine networks offers to the stakeholders a chance of understanding the most sustainable solutions for increasing access to stroke care.