Evaluation of a Telephone Advice System for Remote Intravenous Thrombolysis in Ischemic Stroke: Data From a United Kingdom Network | Journal Scan

Jan 29, 2015
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Authors:
Dutta D, Kendall J, Holmes C, et al.
Citation:
Stroke 2015;Jan 20:[Epub ahead of print].
Summary By:
Melvyn Rubenfire, MD, FACC

Study Questions:

Is remote acute stroke thrombolysis using telephone consultation and teleradiology safe and effective?

Methods:

This was a retrospective study of consecutive patients undergoing thrombolysis between 2012 and 2013 in five hospitals with well-organized stroke services. There were a total of 10 stroke physicians and one neurologist. Thrombolysis treatment decisions were made by the on call “remote” clinician after a discussion with the local “in-house” thrombolysis-certified clinician via a structured checklist. No radiologists were involved after hours. All centers used the plain computed tomography (CT) that was reviewed remotely by the on call clinician as the basis for thrombolysis decisions. The treatment time window was increased from 3 to 4.5 hours in 2012. Remote thrombolysis was compared with thrombolysis delivered in person for symptomatic intracerebral hemorrhage, death within 7 days, and 90-day modified Rankin scores.

Results:

Of 586 patients, 220 (37.5%) were thrombolysed remotely. The two groups were well matched (median age 77 years, 50% women, and National Institute of Health Stroke Scale [NIHSS] 12). Remote thrombolysis increased treatment time by 22 minutes; 94% being done after hours compared to 20% with standard thrombolysis (p < 0.001). Outcomes were not different in the two groups (remote vs. standard): symptomatic intracerebral hemorrhage (3.6% vs. 4.6%), death within 7 days (6.4% vs. 7.1%), modified Rankin score <2 (46.0% vs. 46.1%), and modified Rankin score 6 (15% vs. 17.5%) at 90 days.

Conclusions:

The authors concluded that telephone advice and teleradiology, within an organized system of care, can be an effective method of delivery of intravenous thrombolysis.

Perspective:

The results are impressive and support the endorsement of remote thrombolysis for acute stroke in the 2013 US American Heart Association/American Stroke Association guideline.

Keywords: Cerebral Hemorrhage, Stroke, Telephone, Teleradiology, Thrombolytic Therapy, Retrospective Studies


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