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Stroke ; 34(3): 725-8, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12624298

RESUMO

BACKGROUND AND PURPOSE: Telemedicine is emerging as a potential timesaving, efficient means for evaluating patients experiencing acute stroke. In areas where local stroke care specialists are not available, telemedicine can link an emergency department physician with a specialist in a stroke treatment center. This consultation provides an opportunity for administration of thrombolytic drugs within the short therapeutic time window associated with ischemic stroke. Here, we describe our stroke treatment center experiences and report safe administration of recombinant tissue plasminogen activator (rtPA) during telemedicine consultation. METHODS: The University of Maryland Medical Center uses a triplexed integrated services digital network line providing a 30--frames-per-second video link to St Mary's Hospital >100 miles away. The system uses a pan, tilt, and zoom camera with remote site control, allowing 2-way, real-time, audiovisual communication and CT image transfer. We retrospectively reviewed all acute stroke consultations provided to St Mary's Hospital between 1999 and 2001. RESULTS: We reviewed 50 consultations. Of the 50, 23 were attempted through telemedicine linkage, and 27 were by traditional telephone conversation, followed by transfer. Of the 23 telemedicine consultations, 2 were aborted because of technical difficulties. Of the patients evaluated by traditional means, 1 of 27 (3.8%) received intravenous rtPA; 5 of 21 (23.8%) received rtPA after telemedicine consultation. No patients experienced complications. CONCLUSIONS: Telemedicine consultation provided treatment options not previously available at the remote hospital. Administration of rtPA during telemedicine consultation was feasible and safe, and the system was well received. Lack of reimbursement for telemedicine services will hinder widespread adaptation of this promising technology for remote acute stroke treatment.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Hospitais Comunitários/organização & administração , Avaliação de Processos em Cuidados de Saúde/estatística & dados numéricos , Consulta Remota , Acidente Vascular Cerebral/diagnóstico , Estudos de Viabilidade , Fibrinolíticos/uso terapêutico , Humanos , Maryland , Estudos de Casos Organizacionais , Satisfação do Paciente , Consulta Remota/economia , Consulta Remota/instrumentação , Consulta Remota/métodos , Consulta Remota/tendências , Estudos Retrospectivos , Tamanho da Amostra , Acidente Vascular Cerebral/tratamento farmacológico , Telefone/estatística & dados numéricos , Ativador de Plasminogênio Tecidual/efeitos adversos , Ativador de Plasminogênio Tecidual/uso terapêutico
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