TY - JOUR
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.
N1 - Publisher Copyright:
© 2017 The Author(s). Published by Wolters Kluwer Health, Inc.
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.
AB - 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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U2 - 10.1212/WNL.0000000000003786
DO - 10.1212/WNL.0000000000003786
M3 - Article
C2 - 28275084
AN - SCOPUS:85017140423
SN - 0028-3878
VL - 88
SP - 1305
EP - 1312
JO - Neurology
JF - Neurology
IS - 14
ER -