Telemedicine in Prehospital Stroke Evaluation

Itrat, A. et al. JAMA Neurol. December 7, 2015.

A group of physicians from the Cleveland Clinic Mobile Stroke Treatment Unit released a study this month in JAMA Neurology looking at the use of telemedicine to improve efficiency and time to thrombolysis in stroke care.   The group sought to test whether telemedicine would be reliable and remote physician presence adequate for stroke treatment in Mobile Units.

The study was a prospective observational study on 100 residents of Cleveland with acute stroke like symptoms.  A neurologist evaluated the patients in the Mobile Unit via telemedicine and a radiologist interpreted the CT images obtained by the mobile unit.  The data obtained was compared to a cohort of 100 patients brought to the ED via ambulance for evaluation of stroke during the same year.

In the telemedicine group, ninety –nine out of 100 patients were successfully evaluated with 1 patient not evaluated due to equipment failure.  There were a total of 6 telemedicine disconnections but none of these affected the evaluation.   The times to CT completion and time to thrombolysis were significantly shorter compared to the control groups (13 minutes vs. 18 minutes to CT and 32 minutes vs. 58 minutes to thrombolysis).

The group concluded that prehospital stroke evaluation using telemedicine was feasible and likely cost effective and efficient allowing physicians to remotely cover multiple mobile stroke units and a larger geographic area.

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