Use of Telemedicine to Increase Thrombolysis and Advance Care in Acute Ischemic Stroke

Abstract

The use of the only proven therapy for acute ischemic stroke, intravenous tissue plasminogen activator (tPA), remains disappointingly low. One potential way to increase the use of tPA is by the implementation of telemedicine stroke care networks. Preliminary data from several studies indicate that the safe and expanded use of tPA for ischemic stroke can be accomplished with the help of telemedicine. Telemedicine stroke care networks can also be used in the future to enhance stroke diagnosis with advanced CT and MRI technology and to potentially increase the number of patients referred to tertiary stroke centers for intra-arterial therapies. It is highly likely that telemedicine stroke care will substantially enhance acute stroke therapy for remote and underserved populations.

Revised and Updated Recommendations for the Establishment of Primary Stroke Centers

“…60,61 There are numerous reports and growing experience with telemedicine/telestroke being used successfully in many different healthcare settings (mostly hospital to hospital and physician to hospital links) to reduce time delays and increase the use of acute therapies in a timely manner. 60,[62][63][64][65][66][67][68][69][70][71][72][73][74] The ability to use an air ambulance transportation system may vary depending on local factors (ie, ability to land a helicopter). The use of telemedicine as a direct part of EMS transportation (ie, a link in the ambulance) is an emerging area with some technical and logistical challenges.…”

“…Remote viewing sites and services must have the equipment and infrastructure to ensure that the quality of reviewed images meets appropriate standards. 66,98 -100 There should be written documentation that such scans were performed and read within the specified times and that such scans can be performed on a 24/7 basis. A log book that records such scans with time parameters and interpretation is 1 way to document this capability.…”

Reliability of Prehospital Real-Time Cellular Video Phone in Assessing the Simplified National Institutes of Health Stroke Scale in Patients With Acute Stroke

“…35 The application of NIHSS in its original 1,7,13,14,[17][18][19][20][21][22][23][24] or modified format 8,9,19,30 -32 in evaluating patients with acute stroke has been validated by neurologists, 7,8,10 nonneurologist physicians, 2,4,11 trainees, 12 nurse coordinators, 2,4,10,11,37,38 and emergency medical technicians. 32,39 Studies have confirmed the benefits of telemedicine application of NIHSS in the prehospital setting, 19,20,31,32,40 aiming to decrease ischemic time and facilitate the use of thrombolytic.…”

“…13 Multiple prospective 1,14 and retrospective 15,16 studies have validated the NIHSS when applied remotely using telemedicine technology in patients with acute 1,7,13,14,[17][18][19][20][21][22][23][24] and subacute 25 stroke. The NIHSS score correlates with clinical outcomes 21,[25][26][27][28] and has a formal certification process.…”

Future Neurohospitalist

“…42 Telestroke/telemedicine data suggest that remote acute stroke patient examinations at rural hospital settings are feasible and have good inter-rater reliability compared to those of a face-to-face on-site examiner. [43][44][45][46][47][48][49][50][51][52][53] Teleneurology and telestroke do have certain barriers, legal issues, credentialing, and technical limitations that must be mentioned, however. 54 Barriers for setting up a telemedicine network for remote stroke evaluation include conceptual distrust among the referring hospital system (physicians, administrators, nurses, etc) and concern on the part of consulting neurological subspecialists unfamiliar with the sophisticated system that it may not provide a reliable and secure consultation portal.…”