Telemedicine in Prehospital Stroke Evaluation and Thrombolysis

Abstract

Quiz Ref ID Acute stroke thrombolytic treatment is time sensitive and is usually delivered with the coordination of prehospital care providers and neurologists, physicians, and nurses in the emergency department (ED). Based on data from a pooled analysis of major intravenous tissue plasminogen activator (IV-tPA) trials, benefit is greater with early IV-tPA administration.¹ Many patients are unable to obtain acute stroke treatment because of delays in presentation to the hospital. Studies^2-4 exploring prehospital delays in stroke care have revealed that only 15% to 60% of patients having a stroke are able to reach the hospital within 3 hours of symptom onset and demonstrated that this proportion has not decreased over the last 10 years. Recently, mobile stroke units have been shown to reduce the time to evaluation and thrombolysis in Germany.^5,6 These systems use an ambulance equipped with a computed tomography (CT) system and laboratory testing that brings personnel, including a neurologist, to the scene. Quiz Ref ID Unlike other mobile stroke treatment units (MSTUs), the Cleveland Clinic MSTU solely uses telemedicine for physician presence. Telemedicine allows the remote presence of medical expertise and has wide clinical applications, including the evaluation of patients with acute stroke, which has proven to be highly reliable compared with in-person assessment.^7-13 Two cost-effectiveness analyses of mobile stroke unit systems have suggested favorable economics, especially if the need for on-site expertise can be eliminated by relying on telemedicine.^14,15 We report our initial experience with and the feasibility of an MSTU in Cleveland, Ohio, including the use of telemedicine as a substitute for physician presence, and compare the time efficiency of stroke evaluation in EDs.