Use of a telestroke service for evaluation of non-stroke neurological cases

Abstract

Telemedicine is a growing field in many medical specialties. Within clinical neurosciences one of its largest applications is in acute stroke care. However, little is known about its value and effect in general neurology, despite stroke. In a retrospective survey of 1500 teleconsultations over a time period of 12 months from October 2008 to September 2009, from a large telestroke network in Germany, we evaluated 352 cases with a non-stroke diagnosis. Duration and methods of teleconsultation as well as neurological consultations at bedside and discharge diagnosis were analyzed and compared to stroke cases. Discharge diagnosis was not identical to teleconsultation diagnosis in 48.9% of all non-stroke cases compared to 12.5% of all stroke cases. Duration of teleconsultation was 26.5 min in non-stroke cases compared to 14.3 min for stroke cases. In non-stroke cases other parts of the neurological examination were added to the pure administration of a stroke scale. There were no significant differences between non-stroke cases with correct and incorrect consultation diagnoses concerning in-hospital mortality (4.6 vs. 5.0%) and length of hospital stay (8.3 vs. 7.6 days). We conclude that diagnostic accuracy and protocol routine is not as exact in non-stroke cases compared to acute stroke cases. Other neurologic conditions may need different algorithms for a telemedicine service. Thus experience from a telestroke service cannot be transferred to other neurologic conditions on a routine basis.

The use of national administrative data to describe the spatial distribution of in-hospital mortality following stroke in France, 2008–2011

“…However, an overall evaluation of these telemedicine programs using national claims data is difficult to achieve, as they are often too recent and because the coding of telemedicine procedures is not consistent. Studies to identify patients who have benefitted from telemedicine are nonetheless under way, but researchers need to go back to patients’ medical records at the various establishments [ 40 , 41 ]. Moreover, several tests were conducted with different variables in the AHC for this study, but we chose to represent the analysis that generated the greatest inertia (69.2 %).…”

Telemedicine in General Neurology: Interrater Reliability of Clinical Neurological Examination Via Audio-Visual Telemedicine

“…The main field of development for telemedicine is in acute stroke care and reliability of telestroke after remote examination of stroke patients by audio-visual connection is well established [3][4][5] by testing stroke scales. However, results of studies in telestroke service cannot be generalized into other fields of neurology [6]. Nonetheless, there have been studies on telemedicine situated in general neurology, such as the use of telemedicine in general neurological outpatient ser- vice [7] and attempts have been made to establish guidelines for teleneurology [8].…”

Telemedizin im Neurologischen Hintergrunddienst

“…Dies spiegelt die im Vergleich zur Bewertung von Schlaganfall-Patienten noch schlechtere Standardisierung des Untersuchungsablaufes in der allgemeinen Neurologie wieder. Auch in einer retrospektiven Arbeit fand sich eine längere Untersuchungszeit für Nichtschlaganfälle gegenüber Schlaganfall-Patienten (9). Im weiteren Projektverlauf sollen für verschiedene Gruppen von Leitsymptomen Ablaufstandards auch mit Kameraeinstellungen und Empfehlungen zur Assistenz definiert werden.…”

“…Prinzipiell ließe sich die in den Schlaganfallnetzwerken etablierte Technik auch bei Patienten mit anderen neurologischen Erkrankungen nutzen. In einer kürzlich erschienen Arbeit wurden im "Schlaganfallnetzwerk mit Telemedizin in Nordbayern" (STENO) solche Nichtschlaganfälle retrospektiv aufgearbeitet (9). Es zeigte sich, dass diese Fälle durchaus suffizient bearbeitet werden können, aber eventuell schlechtere Ergebnisse erbringen bzw.…”

“…Davon ausgehend untersuchten wir an einer neurologischen Kli-nik innerhalb des STENO-Netzwerkes die Anwendung der bewährten Technik in der allgemeinen Tätigkeit des fachärztlich neurologischen Hintergrunddienstes im Rahmen einer prospektiven Studie. (9). So ist zum Beispiel im Gegensatz zu mehreren Arbeiten bezüglich telemedizinischer Anwendung von Schlaganfallskalen die allgemeine neurologische Untersuchung nur in einer einzigen Arbeit untersucht worden (4).…”