Telemedicine for Stroke Patients

Many patients with ischemic stroke who are eligible for alteplase therapy do not receive it because the agent must be administered within 3 hours from onset of symptoms and because emergency physicians might want to involve stroke neurologists in primary decision making regarding the use of thrombolytics. Researchers evaluated whether remote consultation with a stroke neurologist could increase appropriate use of thrombolytic agents for stroke patients.

Patients with acute stroke symptoms who presented to one of four remote hospitals from 2004 to 2007 were randomized to telemedicine or telephone-only consultation by neurologists who were National Institute of Health Stroke Scale (NIHSS) certified. During the telemedicine consultation, the consultant took a medical history, performed a physical assessment, calculated the NIHSS score, and reviewed head computed tomography (CT) scans, in concert with the local EP. Telephone consultations differed in that the consultant could not speak directly with or view the patient and relied on the local radiologist’s interpretation of the CT scan. In both scenarios, the consultant made a decision about whether to administer thrombolytic agents. The correctness of the decision — the primary outcome measure — was determined by an independent committee of stroke specialists.

Of 222 patients, 104 in the telemedicine group and 103 in the telephone group completed the study. Mean NIHSS scores at presentation were significantly higher in the telemedicine group than in the telephone group (11.4 vs. 7.7). Correct decision making was significantly more likely in the telemedicine group than in the telephone group (98% vs. 82%; odds ratio, 10.9). However, no differences were noted between groups in any of the secondary outcome variables, including rate of alteplase administration (28% vs. 23%), 90-day functional outcomes, mortality, or rate of intracranial hemorrhage after alteplase administration (7% vs. 8%). The time from call to decision making was significantly longer in the telemedicine group than in the telephone group (65 vs. 55 minutes).