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JAMA Report Shows Effectiveness of Mobile Telestroke Services

A Cleveland Clinic study finds that a first responder unit equipped with telestroke capabilities can reduce diagnosis and treatment times.

By Eric Wicklund

- A study initiated by the Cleveland Clinic has found that stroke patients can be treated more quickly and effectively if the first responder has telemedicine access to a neurologist.

Researchers reported a door-to-CT rate of 13 minutes on average and a door-to-intravenous thrombolysis (IV-tPA administration) rate of 32 minutes on average through the use of a mobile stroke treatment unit. Under normal circumstances, where a patient exhibiting signs of a stroke is rushed to the nearest hospital, those rates average 18 minutes and 58 minutes, respectively.

In a scenario where every minute delayed affects the outcome of a stroke patient, this model could eventually be a life-saver.

As reported in JAMA Neurology, the MSTU launched by the Cleveland Clinic and the Cleveland Emergency Medical Service included a vascular neurologist and a mobile CT system. The unit was dispatched on 100 calls between Nov. 1, 2014 and March 31, 2015 in which the patient was suffering from an acute onset of stroke-like symptoms.  

Once the MSTU unit arrived on the scene, the vascular neurologist examined the patient, then consulted with a neuroradiologist via telemedicine feed. The communication included mobile CT images, and all data was entered into the medical record.

“Our data demonstrated that the evaluation and treatment were not only comparable to ED times but also shorter in terms of CT, laboratory processing and thrombolytic administration,” the researchers wrote in the JAMA article. “Intravenous thrombolysis was successfully administered to 48.5 percent (16 of 33) of patients with suspected stroke and was delivered quickly in the MSTU. The shortest time from the door to IV-tPA administration was 11 minutes, which highlights the potential application of MSTUs in delivering early thrombolysis to patients with stroke thereby reducing disability.”

Telestroke units were among the first telemedicine platforms to be widely adopted by health providers, though those programs primarily consisted of a hub-and-spoke model, with a large hospital acting as the base and serving outlying smaller, remote hospitals and clinics via a telemedicine feed. This is one of the first instances in which the first responder is part of that link.

According to the researchers, the idea of creating a mobile telestroke unit was explored as far back as 2003 in Germany, though early tests were simulated and faced connectivity and door-to-imaging issues. Improvements in wireless network communication have enabled the transmission of high-quality video over cellular networks, the researchers said, so that 94 of the 100 telestroke evaluations were conducted without any technical difficulties, and 99 cases were evaluated successfully.

The researchers concluded that MSTUs are “feasible” and can improve outcomes for stroke victims, and that health systems can save money by creating mobile units that reduce the need for on-site radiologists and neuroradiologists.

But they also cited the small sample size of the study, and noted there were some 217 cancelled dispatches, which adds to the cost-effectiveness of the program. Finally, of the 100 stroke cases, only a third were “initially deemed to represent acute ischemic stroke, but the MSTU protocol was created with high sensitivity for evaluation on the MSTU rather than high specificity for stroke.”

“Further studies should investigate the characteristics of patients who are missed by the screening process and demonstrate whether screening methods can be optimized,” the article concluded.

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