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Mobile stroke treatment units appear feasible
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Researchers found that it is feasible to have mobile stroke treatment units in which a vascular neurologist participates by telemedicine, according to findings published in JAMA Neurology.
If properly handled, mobile stroke treatment units can provide thrombolysis to stroke victims faster than in-hospital treatment. Although early models had a neurologist on-site, researchers investigated whether it would be feasible to have the neurologist participate by telemedicine.
They conducted a prospective observational study of 100 patients in Cleveland with acute onset of stroke-like symptoms between July 18 and Nov. 1, 2014. They compared the evaluation and treatment of those patients with a control group of 56 patients brought to the ED for evaluation of acute onset of stroke-like symptoms during 2014. Process times were counted starting when the patient entered the mobile stroke treatment unit or hospital.
Low rate of technical failure
Ahmed Itrat, MD, from the cerebrovascular center at Cleveland Clinic, and colleagues reported that 99 of the 100 patients in the mobile stroke treatment unit were evaluated successfully, and that median duration of telemedicine evaluation was 20 minutes (interquartile range [IQR], 14-27). The one failure was a connection failure attributed to crew error, and that patient was transported to the closest ED, they reported.
They also reported six telemedicine disconnections, but wrote that none of them lasted longer than 1 minute or had an effect on clinical care.
The time from door to completion of CT was shorter in the mobile stroke treatment unit group than in controls (13 minutes [IQR, 9-21] vs. 18 minutes [IQR, 12-26]; P = .003), as was the time from door to INR result (13 minutes [IQR, 7-18] vs. 44 minutes [IQR, 36-61]; P < .001) and time from door to IV tissue plasminogen activator administration (32 minutes [IQR, 24-47] vs. 58 minutes [IQR, 53-68]; P < .001), according to the researchers.
There was no difference between the groups in time from door to CT interpretation (mobile group, 25 minutes [IQR, 20-29]; controls, 25 minutes [IQR, 19-35]; P = .59), they found.
“The system would allow a physician to cover multiple [mobile stroke treatment units] and broaden the geographic coverage, rendering the concept more efficient and cost-effective,” Itrat and colleagues wrote.
More trials needed
In a related editorial, Martin Ebinger, MD, and Heinrich J. Audebert, MD, both from the Center for Stroke Research and the department of neurology at Charité – Universitätsmedizin Berlin, wrote that “telemedicine could help to defuse the debate on financial investments necessary for advanced prehospital stroke care.”
But before definitive conclusions can be drawn, “we need trials to show improved outcomes in patients treated with specialized stroke ambulances, better 4G/long-term evolution coverage (and subsequent mobile communications technologies) around the globe, and studies comparing outcomes between stroke ambulances staffed with a vascular neurologist vs. telemedicine advice to paramedics,” they wrote. – by Erik Swain
Disclosure: The researchers, Ebinger and Audebert report no relevant financial disclosures.
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