Telemedicine for Prehospital Stroke Care
Can a mobile stroke team, which can provide thrombolysis prior to hospital arrival, improve stroke treatment?
This prospective observational study included a community-based evaluation of a telemedicine program to treat stroke patients in Cleveland, OH. The study was conducted between July 2014 and November 2014 with follow-up through March 2015. The study population included the first 100 Cleveland residents with acute onset of stroke-like symptoms (between 8 am and 8 pm) who were evaluated by the mobile stroke treatment unit (MSTU). This program included a vascular neurologist who evaluated patients via telemedicine, and a neuroradiologist who remotely assessed the mobile computed tomography (CT) scan images. The primary outcomes of interest included process times and problems recorded during evaluation. These outcomes were compared with a control of patients who received traditional care in the emergency department (ED).
Almost all patients (99 of 100) were evaluated successfully. The median duration of evaluation was 20 minutes (interquartile range [IQR], 14-27 minutes) in the telemedicine group. One connection failure occurred and the patient was transported to the ED. There were six additional telemedicine disconnections, none of which lasted longer than 60 seconds or affected clinical care. Time between arrival and CT completion was 13 minutes (IQR, 9-21 minutes) and time from arrival to intravenous thrombolysis was 32 minutes (IQR, 24-47 minutes) in the MSTU group. These were significantly shorter durations than those observed in the control group: 18 minutes [IQR, 12-26 minutes] for arrival to CT completion and 58 minutes [IQR, 53-68 minutes] for arrival to intravenous thrombolysis. Times to CT interpretation did not differ significantly between the groups.
The investigators concluded that use of a mobile unit for stroke care is feasible with a low rate of technical failure and possible faster assessment and treatment.
Use of a mobile team with telemedicine evaluation to reduce duration of stroke care appears promising. Further study including a randomized controlled trial is warranted.
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