TY - JOUR
T1 - Efficacy of telemedicine for stroke
T2 - Pooled analysis of the stroke team remote evaluation using a digital observation camera (STRokE DOC) and STRokE DOC Arizona telestroke trials
AU - Demaerschalk, Bart M.
AU - Raman, Rema
AU - Ernstrom, Karin
AU - Meyer, Brett C.
PY - 2012/4/1
Y1 - 2012/4/1
N2 - Background and Purpose: Telemedicine can disseminate vascular neurology expertise and optimize recombinant tissue plasminogen activator (rt-PA) use for acute ischemic stroke in rural underserved communities. The purpose of this study was to prospectively assess whether telemedicine or telephone was superior for decision-making. Methods: The study design is a pooled analysis of two identically designed randomized controlled trials conducted in a multistate hub and spoke telestroke network setting with acute stroke syndrome patients, comparing telemedicine versus telephone-only consultations. From each trial, common data elements were pooled to assess, principally, for correctness of thrombolysis decision-making. Secondary outcomes included rt-PA use rate, 90-day functional outcome, post-thrombolysis intracranial hemorrhage, and data completeness. Results: Two hundred seventy-six pooled patients were evaluated. Correct thrombolysis eligibility decisions were made more often with telemedicine (96% telemedicine, 83% telephone; odds ratio [OR] 4.2; 95% confidence interval [CI] 1.69-10.46; p=0.002). Intravenous rt-PA usage was 26% (29% telemedicine, 24% telephone; OR 1.27; 95% CI 0.71-2.25; p=0.41). Ninety-day outcomes were not different for Barthel Index, modified Rankin Scale, or mortality. There was no difference in post-thrombolysis intracranial hemorrhage (8% telemedicine, 6% telephone; p>0.999). Conclusions: This pooled analysis supports the hypothesis that stroke telemedicine consultations, compared with telephone-only, result in more accurate decision-making. Together with high rt-PA utilization rate, low post-rt-PA intracranial hemorrhage rate, and acceptable patient outcome, the results confirm that telemedicine is a viable consultative tool for acute stroke. The replication of the hub and spoke network infrastructure supports the generalizability of telemedicine when used in broader settings.
AB - Background and Purpose: Telemedicine can disseminate vascular neurology expertise and optimize recombinant tissue plasminogen activator (rt-PA) use for acute ischemic stroke in rural underserved communities. The purpose of this study was to prospectively assess whether telemedicine or telephone was superior for decision-making. Methods: The study design is a pooled analysis of two identically designed randomized controlled trials conducted in a multistate hub and spoke telestroke network setting with acute stroke syndrome patients, comparing telemedicine versus telephone-only consultations. From each trial, common data elements were pooled to assess, principally, for correctness of thrombolysis decision-making. Secondary outcomes included rt-PA use rate, 90-day functional outcome, post-thrombolysis intracranial hemorrhage, and data completeness. Results: Two hundred seventy-six pooled patients were evaluated. Correct thrombolysis eligibility decisions were made more often with telemedicine (96% telemedicine, 83% telephone; odds ratio [OR] 4.2; 95% confidence interval [CI] 1.69-10.46; p=0.002). Intravenous rt-PA usage was 26% (29% telemedicine, 24% telephone; OR 1.27; 95% CI 0.71-2.25; p=0.41). Ninety-day outcomes were not different for Barthel Index, modified Rankin Scale, or mortality. There was no difference in post-thrombolysis intracranial hemorrhage (8% telemedicine, 6% telephone; p>0.999). Conclusions: This pooled analysis supports the hypothesis that stroke telemedicine consultations, compared with telephone-only, result in more accurate decision-making. Together with high rt-PA utilization rate, low post-rt-PA intracranial hemorrhage rate, and acceptable patient outcome, the results confirm that telemedicine is a viable consultative tool for acute stroke. The replication of the hub and spoke network infrastructure supports the generalizability of telemedicine when used in broader settings.
KW - randomized controlled trials
KW - rural health
KW - rural hospitals
KW - stroke
KW - telemedicine
KW - telestroke
KW - tissue plasminogen activator
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U2 - 10.1089/tmj.2011.0116
DO - 10.1089/tmj.2011.0116
M3 - Article
C2 - 22400970
AN - SCOPUS:84859528967
SN - 1530-5627
VL - 18
SP - 230
EP - 237
JO - Telemedicine and e-Health
JF - Telemedicine and e-Health
IS - 3
ER -