Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis

Ather Taqui, Russell Cerejo, Ahmed Itrat, Farren B.S. Briggs, Andrew P. Reimer, Stacey Winners, Natalie Organek, Andrew B. Buletko, Lila Sheikhi, Sung-Min Cho, Maureen Buttrick, Megan M. Donohue, Zeshaun Khawaja, Dolora Wisco, Jennifer A. Frontera, Andrew N. Russman, Fredric M. Hustey, Damon M. Kralovic, Peter Rasmussen, Ken UchinoMuhammad S. Hussain

Research output: Contribution to journalArticle

Abstract

Objective: To compare the times to evaluation and thrombolytic treatment of patients treated with a telemedicine-enabled mobile stroke treatment unit (MSTU) vs those among patients brought to the emergency department (ED) via a traditional ambulance. Methods: We implemented a MSTU with telemedicine at our institution starting July 18, 2014. A vascular neurologist evaluated each patient via telemedicine and a neuroradiologist and vascular neurologist remotely assessed images obtained by the MSTU CT. Data were entered in a prospective registry. The evaluation and treatment of the first 100 MSTU patients (July 18, 2014-November 1, 2014) was compared to a control group of 53 patients brought to the ED via a traditional ambulance in 2014. Times were expressed as medians with their interquartile ranges. Results: Patient and stroke severity characteristics were similar between 100 MSTU and 53 ED control patients (initial NIH Stroke Scale score 6 vs 7, p = 0.679). There was a significant reduction of median alarm-to-CT scan completion times (33 minutes MSTU vs 56 minutes controls, p < 0.0001), median alarm-to-thrombolysis times (55.5 minutes MSTU vs 94 minutes controls, p < 0.0001), median door-to-thrombolysis times (31.5 minutes MSTU vs 58 minutes controls, p = 0.0012), and symptom-onset-to-thrombolysis times (97 minutes MSTU vs 122.5 minutes controls, p = 0.0485). Sixteen patients evaluated on MSTU received thrombolysis, 25% of whom received it within 60 minutes of symptom onset. Conclusion: Compared with the traditional ambulance model, telemedicine-enabled ambulancebased thrombolysis resulted in significantly decreased time to imaging and treatment.

Original languageEnglish (US)
Pages (from-to)1305-1312
Number of pages8
JournalNeurology
Volume88
Issue number14
DOIs
StatePublished - Apr 4 2017
Externally publishedYes

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Telemedicine
Stroke
Ambulances
Therapeutics
Hospital Emergency Service
Blood Vessels
Registries

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Taqui, A., Cerejo, R., Itrat, A., Briggs, F. B. S., Reimer, A. P., Winners, S., ... Hussain, M. S. (2017). Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis. Neurology, 88(14), 1305-1312. https://doi.org/10.1212/WNL.0000000000003786

Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis. / Taqui, Ather; Cerejo, Russell; Itrat, Ahmed; Briggs, Farren B.S.; Reimer, Andrew P.; Winners, Stacey; Organek, Natalie; Buletko, Andrew B.; Sheikhi, Lila; Cho, Sung-Min; Buttrick, Maureen; Donohue, Megan M.; Khawaja, Zeshaun; Wisco, Dolora; Frontera, Jennifer A.; Russman, Andrew N.; Hustey, Fredric M.; Kralovic, Damon M.; Rasmussen, Peter; Uchino, Ken; Hussain, Muhammad S.

In: Neurology, Vol. 88, No. 14, 04.04.2017, p. 1305-1312.

Research output: Contribution to journalArticle

Taqui, A, Cerejo, R, Itrat, A, Briggs, FBS, Reimer, AP, Winners, S, Organek, N, Buletko, AB, Sheikhi, L, Cho, S-M, Buttrick, M, Donohue, MM, Khawaja, Z, Wisco, D, Frontera, JA, Russman, AN, Hustey, FM, Kralovic, DM, Rasmussen, P, Uchino, K & Hussain, MS 2017, 'Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis', Neurology, vol. 88, no. 14, pp. 1305-1312. https://doi.org/10.1212/WNL.0000000000003786
Taqui A, Cerejo R, Itrat A, Briggs FBS, Reimer AP, Winners S et al. Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis. Neurology. 2017 Apr 4;88(14):1305-1312. https://doi.org/10.1212/WNL.0000000000003786
Taqui, Ather ; Cerejo, Russell ; Itrat, Ahmed ; Briggs, Farren B.S. ; Reimer, Andrew P. ; Winners, Stacey ; Organek, Natalie ; Buletko, Andrew B. ; Sheikhi, Lila ; Cho, Sung-Min ; Buttrick, Maureen ; Donohue, Megan M. ; Khawaja, Zeshaun ; Wisco, Dolora ; Frontera, Jennifer A. ; Russman, Andrew N. ; Hustey, Fredric M. ; Kralovic, Damon M. ; Rasmussen, Peter ; Uchino, Ken ; Hussain, Muhammad S. / Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis. In: Neurology. 2017 ; Vol. 88, No. 14. pp. 1305-1312.
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T1 - Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis

AU - Taqui, Ather

AU - Cerejo, Russell

AU - Itrat, Ahmed

AU - Briggs, Farren B.S.

AU - Reimer, Andrew P.

AU - Winners, Stacey

AU - Organek, Natalie

AU - Buletko, Andrew B.

AU - Sheikhi, Lila

AU - Cho, Sung-Min

AU - Buttrick, Maureen

AU - Donohue, Megan M.

AU - Khawaja, Zeshaun

AU - Wisco, Dolora

AU - Frontera, Jennifer A.

AU - Russman, Andrew N.

AU - Hustey, Fredric M.

AU - Kralovic, Damon M.

AU - Rasmussen, Peter

AU - Uchino, Ken

AU - Hussain, Muhammad S.

PY - 2017/4/4

Y1 - 2017/4/4

N2 - Objective: To compare the times to evaluation and thrombolytic treatment of patients treated with a telemedicine-enabled mobile stroke treatment unit (MSTU) vs those among patients brought to the emergency department (ED) via a traditional ambulance. Methods: We implemented a MSTU with telemedicine at our institution starting July 18, 2014. A vascular neurologist evaluated each patient via telemedicine and a neuroradiologist and vascular neurologist remotely assessed images obtained by the MSTU CT. Data were entered in a prospective registry. The evaluation and treatment of the first 100 MSTU patients (July 18, 2014-November 1, 2014) was compared to a control group of 53 patients brought to the ED via a traditional ambulance in 2014. Times were expressed as medians with their interquartile ranges. Results: Patient and stroke severity characteristics were similar between 100 MSTU and 53 ED control patients (initial NIH Stroke Scale score 6 vs 7, p = 0.679). There was a significant reduction of median alarm-to-CT scan completion times (33 minutes MSTU vs 56 minutes controls, p < 0.0001), median alarm-to-thrombolysis times (55.5 minutes MSTU vs 94 minutes controls, p < 0.0001), median door-to-thrombolysis times (31.5 minutes MSTU vs 58 minutes controls, p = 0.0012), and symptom-onset-to-thrombolysis times (97 minutes MSTU vs 122.5 minutes controls, p = 0.0485). Sixteen patients evaluated on MSTU received thrombolysis, 25% of whom received it within 60 minutes of symptom onset. Conclusion: Compared with the traditional ambulance model, telemedicine-enabled ambulancebased thrombolysis resulted in significantly decreased time to imaging and treatment.

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