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In-transit telemedicine reduces time to treatment for ischemic stroke
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An in-transit telemedicine system is as effective as mobile stroke transport units, but is also a more cost-effective, scalable approach for improving time to treatment for patients with stroke, according to data published in Stroke.
John J. Halperin, MD, chair of the department of neurosciences at Overlook Medical Center in Summit, New Jersey, and colleagues implemented the telemedicine system (InTouch Xpress) in six EDs in the Atlantic Health System between January 2015 and March 2016. Using cellular-connected devices that included a high-definition camera, microphone and screen allowing transparent bidirectional communication, paramedics assisted by teleneurologists evaluated 89 patients with suspected stroke.
“Distinguishing between causes of stroke is crucial because if alteplase is given to a patient with bleeding in the brain, they could die,” Halperin told Cardiology Today.
Mean teleconsult duration was 7.3 minutes (95% CI, 4.9-9.8) among the 15 (17%) who received alteplase (Activase, Genentech) and 4.7 minutes (95% CI, 3.9-5.4) among the 74 who did not. Thirty-nine percent of the teleconsults required reconnection, but connectivity was quickly re-established in all but two cases.
During the same time period, 71 patients with stroke who were treated with alteplase also were transported by EMS, but without the in-transit telemedicine. The mean door-to-needle time was 13 minutes less in the telemedicine group than in the control group (28 vs. 41; P = .02). In addition, mean last-known-well to needle time was 30 minutes less in the telemedicine group than in the control group (92 vs. 122; P = .037).
“The next step is to validate our findings in larger populations,” Halperin said in an interview. “The challenge of the mobile stroke transport units is that the hardware and staffing needs are expensive upfront. The cost–benefit is tenuous. In-transit telestroke is less expensive and a more generalizable model that can have a broader impact.” – by Tracey Romero
Disclosure: The telemedicine units were funded by the Kirby Foundation. Halperin reports serving on the editorial board for Neurology, receiving royalties from Up to Date, receiving honoraria from various academic institutions and organizations, and serving as an expert witness in legal proceedings. One researcher reports speaking for Medtronic and another reports speaking and serving as an expert witness for Teva.
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