Telemedicine and Remote Physician Presence Adequate for Acute Stroke Care

HealthDay News — A mobile stroke treatment unit (MSTU) is feasible for providing acute stroke treatment, according to a study published online December 7 in JAMA Neurology.

In a prospective observational cohort study, Ahmed Itrat, MD, from the Cleveland Clinic, and colleagues examined whether telemedicine is reliable and remote physician presence is adequate for acute stroke treatment using an MSTU. Participants were 100 residents of Cleveland with an acute onset of stroke-like symptoms who were evaluated by the MSTU. The patients were evaluated by a vascular neurologist via telemedicine; a neuroradiologist remotely assessed images obtained by mobile computed tomography.

Ninety-nine of the patients were successfully assessed, with a median duration of assessment of 20 minutes. The researchers found that there was 1 connection failure due to crew error; the patient was transported to the emergency department. Six telemedicine disconnections occurred, none of which lasted for more than 60 seconds or impacted clinical care. The times from door to CT completion and from door to intravenous thrombolysis were 13 and 32 minutes, respectively, in the MSTU group, which were significantly shorter than in the control group (18 and 58 minutes, respectively). There was no between-group difference noted in times to CT interpretation.

“An MSTU using telemedicine is feasible, with a low rate of technical failure, and may provide an avenue for reducing the high cost of such systems,” the authors wrote.

References

1. Ebinger M, Audebert HJ. Switched on–expert advice in prehospital thrombolysis via telemedicine. JAMA Neurol. 2015. doi:10.1001/jamaneurol.2015.3875.
2. Itrat A, Taqui A, Cerejo R, et al; for the Cleveland Pre-Hospital Acute Stroke Treatment (PHAST) Group. Telemedicine in prehospital stroke evaluation and thrombolysis. JAMA Neurol. 2015. doi:10.1001/jamaneurol.2015.3849.