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The Finnish Telestroke Taskforce has established a telemedicine network to assist with acute stroke evaluations. For this study, the taskforce prospectively analyzed the clinical characteristics and 3-month outcomes of patients evaluated via this telemedicine network during a 2-year period. The authors examined outcomes in patients who were evaluated at the single large hub facility and at five community spoke hospitals (all of which have stroke units and thrombolysis services available during regular working hours; telemedicine was used outside of these hours). Follow-up was conducted via in-person or telephone assessment. The investigators used the National Institute of Neurological Disorders and Stroke study definition of symptomatic intracerebral hemorrhage (sICH).
During the study period, telemedicine consultations occurred regarding 106 patients considered potentially eligible for thrombolytic therapy at the spoke facilities. Sixty-one of these patients (57.5%) underwent thrombolysis, a rate higher than in other published telemedicine studies. Reasons for not treating with thrombolysis included mild or resolving symptoms, stroke mimics, large hypodensity on computed tomographic imaging, time since symptom onset greater than the recommended treatment window, multiple potential causes of the stroke, premorbid dependency, severe stroke or NIH Stroke Scale score >25, ICH, elevated blood pressure, or elevated international normalized ratio. After thrombolysis, the sICH rate was 6.7% and 3-month mortality was 11.5%. At 3 months, “good” outcomes (modified Rankin Scale scores [mRS] 0–2) occurred in 49.1% of patients who were treated with thrombolysis at spoke centers and “excellent” outcomes (mRS 0–1) occurred in 29.4% — rates that were comparable to those at the hub (58.1% and 36.8%, respectively).
Sairanen T et al. Two years of Finnish Telestroke: Thrombolysis at spokes equal to that at the hub. Neurology 2011 Mar 29; 76:1145.
Comment
Telestroke enables remote stroke practitioners to evaluate patients' clinical deficits reliably (Class I, Level A) and to render medical decision-making in favor of or against the use of thrombolysis for acute stroke when a bedside practitioner is not immediately available (Class I, Level B; JW Neurology Jul 21 2009). This nonrandomized cohort analysis shows that (1) sustainable telemedicine programs in stroke are feasible, (2) timeframes for acute management are comparable to those for in-person management, (3) high rates of thrombolysis treatment for acute stroke using telemedicine technologies are achievable, and (4) most important, acute stroke treatment guided by telemedicine yields outcomes similar to those of standard bedside evaluations. Although randomized, long-term outcome data are needed, reports such as this help add considerable confidence about the safety and effectiveness of telemedicine for stroke care.