Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Telemedicine Protocols for the Management of Patients with Acute Spontaneous Intracerebral Hemorrhage in Rural and Medically Underserved Areas in Gangwon State : Recommendations for Doctors with Less Expertise at Local Emergency Rooms

  • Hyo Sub Jun (Department of Neurosurgery, Kangwon National University Hospital) ;
  • Kuhyun Yang (Department of Neurosurgery, Gangneung Asan Hospital) ;
  • Jongyeon Kim (Department of Neurosurgery, Yonsei University Wonju College of Medicine) ;
  • Jin Pyeong Jeon (Department of Neurosurgery, Hallym University College of Medicine) ;
  • Sun Jeong Kim (Department of Convergence Software, Hallym University) ;
  • Jun Hyong Ahn (Department of Neurosurgery, Kangwon National University Hospital) ;
  • Seung Jin Lee (Department of Neurosurgery, Kangwon National University Hospital) ;
  • Hyuk Jai Choi (Department of Neurosurgery, Hallym University College of Medicine) ;
  • In Bok Chang (Department of Neurosurgery, Hallym University College of Medicine) ;
  • Jeong Jin Park (Department of Neurology, Konkuk University Medical Center) ;
  • Jong-Kook Rhim (Department of Neurosurgery, Jeju National University College of Medicine) ;
  • Sung-Chul Jin (Department of Neurosurgery, Inje University Haeundae Paik Hospital) ;
  • Sung Min Cho (Department of Neurosurgery, Yonsei University Wonju College of Medicine) ;
  • Sung-Pil Joo (Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Seung Hun Sheen (Department of Neurosurgery, CHA Bundang Medical Center, CHA University) ;
  • Sang Hyung Lee (Department of Neurosurgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine)
  • Received : 2023.09.16
  • Accepted : 2023.10.23
  • Published : 2024.07.01
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Abstract

Previously, we reported the concept of a cloud-based telemedicine platform for patients with intracerebral hemorrhage (ICH) at local emergency rooms in rural and medically underserved areas in Gangwon state by combining artificial intelligence and remote consultation with a neurosurgeon. Developing a telemedicine ICH treatment protocol exclusively for doctors with less ICH expertise working in emergency rooms should be part of establishing this system. Difficulties arise in providing appropriate early treatment for ICH in rural and underserved areas before the patient is transferred to a nearby hub hospital with stroke specialists. This has been an unmet medical need for decades. The available reporting ICH guidelines are realistically applicable in university hospitals with a well-equipped infrastructure. However, it is very difficult for doctors inexperienced with ICH treatment to appropriately select and deliver ICH treatment based on the guidelines. To address these issues, we developed an ICH telemedicine protocol. Neurosurgeons from four university hospitals in Gangwon state first wrote the guidelines, and professors with extensive ICH expertise across the country revised them. Guidelines and recommendations for ICH management were described as simply as possible to allow more doctors to use them easily. We hope that our effort in developing the telemedicine protocols will ultimately improve the quality of ICH treatment in local emergency rooms in rural and underserved areas in Gangwon state.

Keywords

Acknowledgement

This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number : 1711179390, RS-2022-00155659).

References

  1. An SJ, Kim TJ, Yoon BW : Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: an update. J Stroke 19 : 3-10, 2017 https://doi.org/10.5853/jos.2016.00864
  2. Angileri FF, Cardali S, Conti A, Raffa G, Tomasello F : Telemedicine-assisted treatment of patients with intracerebral hemorrhage. Neurosurg Focus 32 : E6, 2012
  3. Arima H, Wang JG, Huang Y, Heeley E, Skulina C, Parsons MW, et al. : Significance of perihematomal edema in acute intracerebral hemorrhage: the INTERACT trial. Neurology 73 : 1963-1968, 2009 https://doi.org/10.1212/WNL.0b013e3181c55ed3
  4. Balami JS, Buchan AM : Complications of intracerebral haemorrhage. Lancet Neurol 11 : 101-118, 2012 https://doi.org/10.1016/S1474-4422(11)70264-2
  5. Benghanem S, Mazeraud A, Azabou E, Chhor V, Shinotsuka CR, Claassen J, et al. : Brainstem dysfunction in critically ill patients. Crit Care 24 : 5, 2020
  6. Boehme AK, Hays AN, Kicielinski KP, Arora K, Kapoor N, Lyerly MJ, et al. : Systemic inflammatory response syndrome and outcomes in intracerebral hemorrhage. Neurocrit Care 25 : 133-140, 2016 https://doi.org/10.1007/s12028-016-0255-9
  7. Brouwers HB, Greenberg SM : Hematoma expansion following acute intracerebral hemorrhage. Cerebrovasc Dis 35 : 195-201, 2013 https://doi.org/10.1159/000346599
  8. Burneo JG, Fang J, Saposnik G; Investigators of the Registry of the Canadian Stroke Network : Impact of seizures on morbidity and mortality after stroke: a Canadian multi-centre cohort study. Eur J Neurol 17 : 52-58, 2010 https://doi.org/10.1111/j.1468-1331.2009.02739.x
  9. Carney N, Totten AM, Cheney T, Jungbauer R, Neth MR, Weeks C, et al. : Prehospital airway management: a systematic review. Prehosp Emerg Care 26 : 716-727, 2022
  10. Charidimou A, Imaizumi T, Moulin S, Biffi A, Samarasekera N, Yakushiji Y, et al. : Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds: a meta-analysis. Neurology 89 : 820-829, 2017 https://doi.org/10.1212/WNL.0000000000004259
  11. Chen H, Song Z, Dennis JA : Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury. Cochrane Database Syst Rev 12 : CD010904, 2019
  12. Cho KC, Kim H, Suh SH : Trends in mortality from hemorrhagic stroke in Korea from 2012 to 2020. Neurointervention 17 : 87-92, 2022 https://doi.org/10.5469/neuroint.2022.00220
  13. Claassen J, Jette N, Chum F, Green R, Schmidt M, Choi H, et al. : Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology 69 : 1356-1365, 2007 https://doi.org/10.1212/01.wnl.0000281664.02615.6c
  14. Dastur CK, Yu W : Current management of spontaneous intracerebral haemorrhage. Stroke Vasc Neurol 2 : 21-29, 2017 https://doi.org/10.1136/svn-2016-000047
  15. De Herdt V, Dumont F, Henon H, Derambure P, Vonck K, Leys D, et al. : Early seizures in intracerebral hemorrhage: incidence, associated factors, and outcome. Neurology 77 : 1794-1800, 2011 https://doi.org/10.1212/WNL.0b013e31823648a6
  16. Doria JW, Forgacs PB : Incidence, implications, and management of seizures following ischemic and hemorrhagic stroke. Curr Neurol Neurosci Rep 19 : 37, 2019
  17. Fernando SM, Qureshi D, Talarico R, Tanuseputro P, Dowlatshahi D, Sood MM, et al. : Intracerebral hemorrhage incidence, mortality, and association with oral anticoagulation use: a population study. Stroke 52 : 1673-1681, 2021 https://doi.org/10.1161/STROKEAHA.120.032550
  18. Gravesteijn BY, Sewalt CA, Nieboer D, Menon DK, Maas A, Lecky F, et al. : Tracheal intubation in traumatic brain injury: a multicentre prospective observational study. Br J Anaesth 125 : 505-517, 2020 https://doi.org/10.1016/j.bja.2020.05.067
  19. Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, et al. : 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke 53 : e282-e361, 2022
  20. Haapaniemi E, Strbian D, Rossi C, Putaala J, Sipi T, Mustanoja S, et al. : The CAVE score for predicting late seizures after intracerebral hemorrhage. Stroke 45 : 1971-1976, 2014 https://doi.org/10.1161/STROKEAHA.114.004686
  21. Health Insurance Review & Assessment Service : Analysis of Customized Healthcare Status by Local Governments. Wonju : Health Insurance Review & Assessment Service, 2023
  22. Hoh BL, Ko NU, Amin-Hanjani S, Chou SH-Y, Cruz-Flores S, Dangayach NS, et al. : 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke 54 : e314-e370, 2023
  23. Hong KS, Bang OY, Kang DW, Yu KH, Bae HJ, Lee JS, et al. : Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the Korean Stroke Society and clinical research center for stroke. J Stroke 15 : 2-20, 2013 https://doi.org/10.5853/jos.2013.15.1.2
  24. Hong KS, Bang OY, Kim JS, Heo JH, Yu KH, Bae HJ, et al. : Stroke statistics in Korea: part II stroke awareness and acute stroke care, a report from the Korean Stroke Society and clinical research center for stroke. J Stroke 15 : 67-77, 2013 https://doi.org/10.5853/jos.2013.15.2.67
  25. Im SI : What regional disparity trends of cardiovascular mortality have changed in 2019 compared to the 1980s? Korean Circ J 52 : 844-846, 2022 https://doi.org/10.4070/kcj.2022.0276
  26. Jin Z, Chen Y : Telemedicine in the Cloud Era: prospects and challenges. Ieee Pervasive Comput 14 : 54-61, 2015 https://doi.org/10.1109/MPRV.2015.19
  27. Jun HS, Yang K, Kim J, Jeon JP, Ahn JH, Lee SJ, et al. : Development of cloud-based telemedicine platform for acute intracerebral hemorrhage in Gangwon-do : concept and protocol. J Korean Neurosurg Soc 66 : 488-493, 2023 https://doi.org/10.3340/jkns.2022.0256
  28. Karhunen H, Jolkkonen J, Sivenius J, Pitkanen A : Epileptogenesis after experimental focal cerebral ischemia. Neurochem Res 30 : 1529-1542, 2005 https://doi.org/10.1007/s11064-005-8831-y
  29. Kim E, Baek J, Kim M, Lee H, Bae JW, Kim HC : Trends in regional disparity in cardiovascular mortality in Korea, 1983-2019. Korean Circ J 52 : 829-843, 2022 https://doi.org/10.4070/kcj.2022.0156
  30. Kim JE, Ko SB, Kang HS, Seo DH, Park SQ, Sheen SH, et al. : Clinical practice guidelines for the medical and surgical management of primary intracerebral hemorrhage in Korea. J Korean Neurosurg Soc 56 : 175-187, 2014 https://doi.org/10.3340/jkns.2014.56.3.175
  31. Koenig MA, Bryan M, Lewin JL 3rd, Mirski MA, Geocadin RG, Stevens RD : Reversal of transtentorial herniation with hypertonic saline. Neurology 70 : 1023-1029, 2008 https://doi.org/10.1212/01.wnl.0000304042.05557.60
  32. Kongwad LI, Hegde A, Menon G, Nair R : Influence of admission blood glucose in predicting outcome in patients with spontaneous intracerebral hematoma. Front Neurol 9 : 725, 2018
  33. Kuohn LR, Witsch J, Steiner T, Sheth KN, Kamel H, Navi BB, et al. : Early deterioration, hematoma expansion, and outcomes in deep versus lobar intracerebral hemorrhage: the FAST trial. Stroke 53 : 2441-2448, 2022 https://doi.org/10.1161/STROKEAHA.121.037974
  34. Lee SU, Kim T, Kwon OK, Bang JS, Ban SP, Byoun HS, et al. : Trends in the incidence and treatment of cerebrovascular diseases in Korea : part I. Intracranial aneurysm, intracerebral hemorrhage, and arteriovenous malformation. J Korean Neurosurg Soc 63 : 56-68, 2020 https://doi.org/10.3340/jkns.2018.0179
  35. Li Z, You M, Long C, Bi R, Xu H, He Q, et al. : Hematoma expansion in intracerebral hemorrhage: an update on prediction and treatment. Front Neurol 11 : 702, 2020
  36. Liu J, Xu H, Chen Q, Zhang T, Sheng W, Huang Q, et al. : Prediction of hematoma expansion in spontaneous intracerebral hemorrhage using support vector machine. EBioMedicine 43 : 454-459, 2019 https://doi.org/10.1016/j.ebiom.2019.04.040
  37. May N, Anderson K : Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: suxamethonium (succinylcholine) for RSI and intubation in head injury. Emerg Med J 29 : 511-514, 2012 https://doi.org/10.1136/emermed-2012-201374.4
  38. McGurgan IJ, Ziai WC, Werring DJ, Al-Shahi Salman R, Parry-Jones AR : Acute intracerebral haemorrhage: diagnosis and management. Pract Neurol 21 : 128-136, 2020 https://doi.org/10.1136/practneurol-2020-002763
  39. Mehta A, Zusman BE, Choxi R, Shutter LA, Yassin A, Antony A, et al. : Seizures after intracerebral hemorrhage: incidence, risk factors, and impact on mortality and morbidity. World Neurosurg 112 : e385-e392, 2018 https://doi.org/10.1016/j.wneu.2018.01.052
  40. Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, et al. : Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 41 : 2108-2129, 2010 https://doi.org/10.1161/STR.0b013e3181ec611b
  41. Mullen MT, Kasner SE, Messe SR : Seizures do not increase in-hospital mortality after intracerebral hemorrhage in the nationwide inpatient sample. Neurocrit Care 19 : 19-24, 2013 https://doi.org/10.1007/s12028-012-9791-0
  42. Murthy SB, Moradiya Y, Dawson J, Lees KR, Hanley DF, Ziai WC, et al. : Perihematomal edema and functional outcomes in intracerebral hemorrhage: influence of hematoma volume and location. Stroke 46 : 3088-3092, 2015 https://doi.org/10.1161/STROKEAHA.115.010054
  43. Naidech AM, Garg RK, Liebling S, Levasseur K, Macken MP, Schuele SU, et al. : Anticonvulsant use and outcomes after intracerebral hemorrhage. Stroke 40 : 3810-3815, 2009 https://doi.org/10.1161/STROKEAHA.109.559948
  44. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group : Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333 : 1581-1587, 1995 https://doi.org/10.1056/NEJM199512143332401
  45. Passero S, Rocchi R, Rossi S, Ulivelli M, Vatti G : Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia 43 : 1175-1180, 2002 https://doi.org/10.1046/j.1528-1157.2002.00302.x
  46. Rangel-Castilla L, Gopinath S, Robertson CS : Management of intracranial hypertension. Neurol Clin 26 : 521-541, x, 2008 https://doi.org/10.1016/j.ncl.2008.02.003
  47. Robinson N, Clancy M : In patients with head injury undergoing rapid sequence intubation, does pretreatment with intravenous lignocaine/ lidocaine lead to an improved neurological outcome? A review of the literature. Emerg Med J 18 : 453-457, 2001 https://doi.org/10.1136/emj.18.6.453
  48. Seder DB, Riker RR, Jagoda A, Smith WS, Weingart SD : Emergency neurological life support: airway, ventilation, and sedation. Neurocrit Care 17 Suppl 1 : S4-S20, 2012 https://doi.org/10.1007/s12028-012-9753-6
  49. Steiner T, Al-Shahi Salman R, Beer R, Christensen H, Cordonnier C, Csiba L, et al. : European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke 9 : 840-855, 2014 https://doi.org/10.1111/ijs.12309
  50. Stiell IG, Nesbitt LP, Pickett W, Munkley D, Spaite DW, Banek J, et al. : The OPALS major trauma study: impact of advanced life-support on survival and morbidity. CMAJ 178 : 1141-1152, 2008 https://doi.org/10.1503/cmaj.071154
  51. Susanto M, Riantri I : Optimal dose and concentration of hypertonic saline in traumatic brain injury: a systematic review. Medeni Med J 37 : 203-211, 2022 https://doi.org/10.4274/MMJ.galenos.2022.75725
  52. Tan G, Zhou J, Yuan D, Sun S : Formula for use of mannitol in patients with intracerebral haemorrhage and high intracranial pressure. Clin Drug Investig 28 : 81-87, 2008 https://doi.org/10.2165/00044011-200828020-00002
  53. Tarwade P, Smischney NJ : Endotracheal intubation sedation in the intensive care unit. World J Crit Care Med 11 : 33-39, 2022 https://doi.org/10.5492/wjccm.v11.i1.33
  54. Tran QK, Bzhilyanskaya V, Lurie T, Fairchild M, Rehan MA, Rashid A, et al. : Phenytoin prophylaxis and functional outcomes following spontaneous intracerebral hemorrhage: a systematic review and meta-analysis. J Neurol Sci 429 : 117624, 2021
  55. van der Jagt M : Fluid management of the neurological patient: a concise review. Crit Care 20 : 126, 2016
  56. Wagner I, Hauer EM, Staykov D, Volbers B, Dorfler A, Schwab S, et al. : Effects of continuous hypertonic saline infusion on perihemorrhagic edema evolution. Stroke 42 : 1540-1545, 2011 https://doi.org/10.1161/STROKEAHA.110.609479
  57. Wilkinson DA, Pandey AS, Thompson BG, Keep RF, Hua Y, Xi G : Injury mechanisms in acute intracerebral hemorrhage. Neuropharmacology 134(Pt B) : 240-248, 2018 https://doi.org/10.1016/j.neuropharm.2017.09.033
  58. Wilson BR, Bruno J, Duckwitz M, Akers N, Jeanmonod D, Jeanmonod R : Prehospital end-tidal CO2 as an early marker for transfusion requirement in trauma patients. Am J Emerg Med 45 : 254-257, 2021 https://doi.org/10.1016/j.ajem.2020.08.056
  59. Yang J, Arima H, Wu G, Heeley E, Delcourt C, Zhou J, et al. : Prognostic significance of perihematomal edema in acute intracerebral hemorrhage: pooled analysis from the intensive blood pressure reduction in acute cerebral hemorrhage trial studies. Stroke 46 : 1009-1013, 2015 https://doi.org/10.1161/STROKEAHA.114.007154
  60. Zheng J, Yu Z, Ma L, Guo R, Lin S, You C, et al. : Association between blood glucose and functional outcome in intracerebral hemorrhage: a systematic review and meta-analysis. World Neurosurg 114 : e756-e765, 2018 https://doi.org/10.1016/j.wneu.2018.03.077