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OBJECTIVE: Patients with ischemic stroke treated with tissue plasminogen activator (rt-PA) have better outcomes when treated closer to the time of symptom onset and within the 3-hour window. We previously demonstrated the clinical use of TeleBAT, a mobile telemedicine system for stroke. We tested the impact of that system on time to treatment for patients with acute stroke. METHODS: Validity and reliability were tested by comparing neurologic examination scores obtained using our wireless system, which transmits video of a patient from a moving ambulance to desktop computers, with those obtained using the National Institute of Neurological Disorders and Stroke training videotape. TeleBAT validity and good interrater reliability were defined a priori as a kappa statistic of r > 0.5. We compared the average time to treatment for our TeleBAT-evaluated intervention group with that for our control group. The intervention group consisted of two actor patients with stroke mimicking 12 stroke scenarios and evaluated using TeleBAT. The control group consisted of patients with stroke evaluated and treated with rt-PA on arrival to the emergency department. Data were analyzed using standard t test. RESULTS: National Institutes of Health Stroke Scale items calculated by the neurologists suggest TeleBAT is valid for assessing patients with stroke remotely. Interrater reliability was high: the neurologists gleaned the same information from TeleBAT transmissions. Kappa values for both validity and reliability exceeded 0.5. The mean time to treatment for patients assessed by TeleBAT was 17 +/- 4 minutes compared with 33 +/- 17 minutes for our control group (P = .0033). CONCLUSION: TeleBAT seems to be a valid and reliable means of evaluating stroke neurologic deficits. Time to treatment was shortened using ambulance transport time to evaluate patients as candidates for thrombolytic therapy. Future studies should use a randomized design with patients with acute stroke.
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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.
