Telemedicine in Prehospital Stroke Evaluation and Thrombolysis

Itrat, Ahmed; Taqui, Ather; Cerejo, Russell; Briggs, Farren; Cho, Sung Min; Organek, Natalie; Reimer, Andrew P.; Winners, Stacey; Rasmussen, Peter A.; Hussain, Muhammad Shazam; Uchino, Ken

doi:10.1001/jamaneurol.2015.3849

Cited by 120 publications

(117 citation statements)

References 23 publications

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…121,122 In the United States, several ongoing pilot studies of mobile stroke units suggest that the model is robust and that a teleneurologist may be able to substitute for an onboard neurologist. 123,124 If proven effective and generalizable, these mobile stroke units have the potential to transform acute stroke care.…”

Section: Mobile Stroke Unitsmentioning

confidence: 99%

Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association

Schwamm¹,

Chumbler²,

Brown³

et al. 2017

Circulation

172

154

View full text Add to dashboard Cite

ABSTRACT:The aim of this policy statement is to provide a comprehensive review of the scientific evidence evaluating the use of telemedicine in cardiovascular and stroke care and to provide consensus policy suggestions. We evaluate the effectiveness of telehealth in advancing healthcare quality, identify legal and regulatory barriers that impede telehealth adoption or delivery, propose steps to overcome these barriers, and identify areas for future research to ensure that telehealth continues to enhance the quality of cardiovascular and stroke care. The result of these efforts is designed to promote telehealth models that ensure better patient access to high-quality cardiovascular and stroke care while striving for optimal protection of patient safety and privacy. INTRODUCTION Telehealth: Opportunity to Reduce the Costs and Burden of Cardiovascular Disease and StrokeThe United States finds itself at a pivotal moment in the history of medicine when the annual growth in US healthcare spending increased to 5.3% in 2014, up from 2.9% in 2013, after 5 consecutive years of historically low growth.1 Spending on federal healthcare programs continues to grow significantly.2 Regardless, the need to provide high-quality care continues. More than 85 million Americans (≈26% of the US population) suffer from cardiovascular disease (CVD), and nearly 7 million (2.2%) are stroke survivors. CVD and stroke cost the US healthcare system more than $320 billion and $33 billion, respectively, each year, and by 2030, annual costs of CVD and stroke are projected to balloon to nearly $1 trillion.3 Now more than ever, strategies are needed to increase the value of health care by increasing the quality of care and lowering costs.Enhancing patient access to care via telehealth is an important strategy to help address this challenge. Telehealth, as defined by Office for the Advancement of Telehealth, comprises the use of telecommunications and information technologies to share information and to provide clinical care, education, public health, and administrative services at a distance. 4 Telehealth is a broad term that encompasses many digital health technologies, including telemedicine, eHealth, connected health, and mHealth. Telehealth is a new method of enabling care delivery that has the potential to help transform the healthcare system, to reduce costs, and to increase quality, patient-centeredness, and patient satisfaction. [5][6][7] In particular, telehealth may increase access and convenience for patients with CVD and stroke.8 This is especially true for vulnerable patients with CVD or stroke who, because of their geographical location, physical disability, advanced chronic disease, or difficulty with POLICY STATEMENTSsecuring transportation, may not otherwise access specialty healthcare services. 6,7 Yet, telehealth is underused for the management of CVD and stroke, and several barriers to the successful implementation of telehealth interventions for CVD and stroke exist, including cultural, financial, and legal or regulatory const...

show abstract

Section: Mobile Stroke Unitsmentioning

confidence: 99%

Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association

Schwamm¹,

Chumbler²,

Brown³

et al. 2017

Circulation

172

154

View full text Add to dashboard Cite

show abstract

“…5,8 Acceptance among patients and EMS has been uniformly positive. There are obvious challenges examining patients restrained on stretchers in moving vehicles, and maintaining cellular connectivity, but neither precluded obtaining useful information.…”

Section: Discussionmentioning

confidence: 97%

“…Because improved in-hospital processes have reduced door-to-needle (DTN) time, 4 focus has shifted to prehospital time. [5][6][7][8] Emergency medical services' (EMS) identification of likely strokes helps, 9,10 and in-ambulance teleneurology has been considered but not tested clinically. 11,12 Mobile stroke transport units (MSTUs), computed tomographic scanner-equipped ambulances with a neurologist, either in person or by telemedicine, 8 to assess thrombolytic appropriateness and oversee treatment, in the prehospital setting, decrease treatment time 25 minutes.…”

mentioning

confidence: 99%

“…[5][6][7][8] Emergency medical services' (EMS) identification of likely strokes helps, 9,10 and in-ambulance teleneurology has been considered but not tested clinically. 11,12 Mobile stroke transport units (MSTUs), computed tomographic scanner-equipped ambulances with a neurologist, either in person or by telemedicine, 8 to assess thrombolytic appropriateness and oversee treatment, in the prehospital setting, decrease treatment time 25 minutes. 5,8 However, MSTUs cost US$0.75M to $1.4M 5 and require a computed tomographic technologist, an emergency medical technician, and a licensed healthcare practitioner to administer medication, incurring operating costs that can exceed US$1M/y.…”

mentioning

confidence: 99%

“…11,12 Mobile stroke transport units (MSTUs), computed tomographic scanner-equipped ambulances with a neurologist, either in person or by telemedicine, 8 to assess thrombolytic appropriateness and oversee treatment, in the prehospital setting, decrease treatment time 25 minutes. 5,8 However, MSTUs cost US$0.75M to $1.4M 5 and require a computed tomographic technologist, an emergency medical technician, and a licensed healthcare practitioner to administer medication, incurring operating costs that can exceed US$1M/y. Consequently, centers use a single MSTU with limited access hours; several operate alternate weeks.…”

mentioning

confidence: 99%

See 2 more Smart Citations

In-Transit Telemedicine Speeds Ischemic Stroke Treatment

Belt

Felberg

Rubin

et al. 2016

Stroke

View full text Add to dashboard Cite

show abstract

Prehospital Stroke Management Optimized by Use of Clinical Scoring vs Mobile Stroke Unit for Triage of Patients With Stroke

et al. 2019

View full text Add to dashboard Cite

IMPORTANCE Transferring patients with large-vessel occlusion (LVO) or intracranial hemorrhage (ICH) to hospitals not providing interventional treatment options is an unresolved medical problem. OBJECTIVE To determine how optimized prehospital management (OPM) based on use of the Los Angeles Motor Scale (LAMS) compares with management in a Mobile Stroke Unit (MSU) in accurately triaging patients to the appropriate hospital with (comprehensive stroke center [CSC]) or without (primary stroke center [PSC]) interventional treatment. DESIGN, SETTING, AND PARTICIPANTS In this randomized multicenter trial with 3-month follow-up, patients were assigned week-wise to one of the pathways between June 15, 2015, and November 15, 2017, in 2 regions of Saarland, Germany; 708 of 824 suspected stroke patients did not meet inclusion criteria, resulting in a study population of 116 adult patients. INTERVENTIONS Patients received either OPM based on a standard operating procedure that included the use of the LAMS (cut point Ն4) or management in an MSU (an ambulance with vascular imaging, point-of-care laboratory, and telecommunication capabilities). MAIN OUTCOMES AND MEASURESThe primary end point was the proportion of patients accurately triaged to either CSCs (LVO, ICH) or PSCs (others).RESULTS A predefined interim analysis was performed after 116 patients of the planned 232 patients had been enrolled. Of these, 53 were included in the OPM group (67.9% women; mean [SD] age, 74 [11] years) and 63 in the MSU group (57.1% women; mean [SD] age, 75 [11] years). The primary end point, an accurate triage decision, was reached for 37 of 53 patients (69.8%) in the OPM group and for 63 of 63 patients (100%) in the MSU group (difference, 30.2%; 95% CI, 17.8%-42.5%; P < .001). Whereas 7 of 17 OPM patients (41.2%) with LVO or ICH required secondary transfers from a PSC to a CSC, none of the 11 MSU patients (0%) required such transfers (difference, 41.2%; 95% CI, 17.8%-64.6%; P = .02). The LAMS at a cut point of 4 or higher led to an accurate diagnosis of LVO or ICH for 13 of 17 patients (76.5%; 6 triaged to a CSC) and of LVO selectively for 7 of 9 patients (77.8%; 2 triaged to a CSC). Stroke management metrics were better in the MSU group, although patient outcomes were not significantly different. CONCLUSIONS AND RELEVANCEWhereas prehospital management optimized by LAMS allows accurate triage decisions for approximately 70% of patients, MSU-based management enables accurate triage decisions for 100%. Depending on the specific health care environment considered, both approaches are potentially valuable in triaging stroke patients.

show abstract

Telemedicine in Prehospital Stroke Evaluation and Thrombolysis

Cited by 120 publications

References 23 publications

Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association

Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association

In-Transit Telemedicine Speeds Ischemic Stroke Treatment

Prehospital Stroke Management Optimized by Use of Clinical Scoring vs Mobile Stroke Unit for Triage of Patients With Stroke

Contact Info

Product

Resources

About