Effect of teleconsultation on the application of thrombolytic therapy in stroke patients in the emergency department.
Remote connection
Stroke
Teleconference
Thrombolytics
Journal
Irish journal of medical science
ISSN: 1863-4362
Titre abrégé: Ir J Med Sci
Pays: Ireland
ID NLM: 7806864
Informations de publication
Date de publication:
19 Aug 2023
19 Aug 2023
Historique:
received:
27
06
2023
accepted:
09
08
2023
medline:
19
8
2023
pubmed:
19
8
2023
entrez:
19
8
2023
Statut:
aheadofprint
Résumé
Recently, telemedicine has become a widely used method worldwide for the treatment of patients with acute ischemic stroke in hospitals where neurologists are unavailable. The purpose of this study was to determine the accuracy and reliability of treatment decisions made by remote neurologists via teleconference assisted by emergency physicians in acute stroke cases and to determine whether the use of teleconsultation would lead to any delays in assessment and treatment decisions. This single-center and prospective study was performed with 104 patients who met the inclusion criteria. Patients were concurrently assessed by a teleneurologist (TN) experienced in stroke and an on-site neurologist (OS-N). The TN performed their assessment via teleconference and assisted by an emergency physician for test results and physical examination. NIHSS (The National Institutes of Health Stroke Scale) scores, assessment times, treatment decisions by the two neurologists, and patient outcomes were recorded separately. The TN was asked to rate the quality of communication. Of the 104 patients in the study, 59.6% (n = 62) were men and the median age was 66 (interquartile range = 56-78) years. The median duration of assessment by the OS-N was 30 (18-45) min and the median duration of assessment by the TN was 6 (5-8) min; the duration of assessment by the TN was significantly shorter (6.56 min vs. 33.35 min; Z = 8.669; p < 0.001). The median rating assigned by the TN to the quality of teleconsultation was 5.0 (4.25-5.0) (Table 1). The NIHSS scores assigned by both neurologists showed significant correlation (p < 0.001). Analysis of the agreement between the OS-N and TN in their treatment decisions yielded a Kappa value of 74.3% for interrater agreement. Teleconsultation was a successful and reliable strategy in assessing patients with ischemic stroke and making decisions for IV-tPA. Moreover, patient assessment via teleconsultation was less time consuming. The results of the study are promising for the use of teleconsultation in the future.
Identifiants
pubmed: 37597035
doi: 10.1007/s11845-023-03497-1
pii: 10.1007/s11845-023-03497-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.
Références
Telefarlı MA, Akman C, Akdur O et al (2020) The effect of blood lactate level on prognosis in cerebrovascular disease. Ann Clin Analytic Med 11:219–223
Phipps MS, Cronin CA (2020) Management of acute ischemic stroke. BMJ. 368:l6983. Published 2020 Feb 13
Rai AT, Seldon AE, Boo S et al (2017) A population-based incidence of acute large vessel occlusions and thrombectomy eligible patients indicates significant potential for growth of endovascular stroke therapy in the USA. J Neurointerv Surg 9(8):722–726
doi: 10.1136/neurintsurg-2016-012515
pubmed: 27422968
Emberson J, Lees KR, Lyden P et al (2014) Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 384(9958):1929–1935
doi: 10.1016/S0140-6736(14)60584-5
pubmed: 25106063
pmcid: 4441266
Saver JL, Goyal M, van der Lugt A et al (2016) Time to Treatment with Endovascular Thrombectomy and Outcomes from Ischemic Stroke: A Meta-analysis. JAMA. 316(12):1279–1288
doi: 10.1001/jama.2016.13647
pubmed: 27673305
Kim JT, Fonarow GC, Smith EE et al (2014) Treatment with Tissue Plasminogen Activator in the Golden Hour and the Shape of the 4.5-Hour Time-Benefit Curve in the National United States Get with the Guidelines-Stroke Population. Circulation 135(2):128-139
Lees KR, Bluhmki E, von Kummer R et al (2010) Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 375(9727):1695–1703
doi: 10.1016/S0140-6736(10)60491-6
pubmed: 20472172
Wu TC, Parker SA, Jagolino A et al (2017) Telemedicine Can Replace the Neurologist on a Mobile Stroke Unit. Stroke 48(2):493–496
doi: 10.1161/STROKEAHA.116.015363
pubmed: 28082671
Van Hooff RJ, De Smedt A, De Raedt S et al (2013) Unassisted assessment of stroke severity using telemedicine. Stroke 44(5):1249–1255
doi: 10.1161/STROKEAHA.111.680868
pubmed: 23444305
Liman TG, Winter B, Waldschmidt C et al (2012) Telestroke ambulances in prehospital stroke management: concept and pilot feasibility study. Stroke 43(8):2086–2090
doi: 10.1161/STROKEAHA.112.657270
pubmed: 22693132
Lyden P, Raman R, Liu L et al (2009) National Institutes of Health Stroke Scale certification is reliable across multiple venues. Stroke 40(7):2507–2511
doi: 10.1161/STROKEAHA.108.532069
pubmed: 19520998
pmcid: 2726278
Berekashvili K, Zha AM, Abdel-Al M et al (2020) Emergency Medicine Physicians Accurately Select Acute Stroke Patients for Tissue-Type Plasminogen Activator Treatment Using a Checklist. Stroke. 51(2):663–665
doi: 10.1161/STROKEAHA.119.026948
pubmed: 31771461
LaMonte MP, Bahouth MN, Hu P et al (2003) Telemedicine for acute stroke: triumphs and pitfalls. Stroke. 34(3):725–728
doi: 10.1161/01.STR.0000056945.36583.37
pubmed: 12624298
Mikulik R, Alexandrov AV, Ribo M et al (2006) Telemedicine-guided carotid and transcranial ultrasound: a pilot feasibility study. Stroke. 37(1):229–230
doi: 10.1161/01.STR.0000196988.45318.97
pubmed: 16339460
Demaerschalk BM, Bobrow BJ, Raman R et al (2010) Stroke team remote evaluation using a digital observation camera in Arizona: the initial mayo clinic experience trial. Stroke 41(6):1251–1258
doi: 10.1161/STROKEAHA.109.574509
pubmed: 20431081
pmcid: 2876204
Lin CH, Lee KW, Chen TC et al (2022) Quality and safety of Telemedicine in acute ischemic stroke: Early experience in Taiwan. J Formos Med Assoc 121(1 Pt 2):314–318
doi: 10.1016/j.jfma.2021.04.024
pubmed: 33994236
Amadi-Obi A, Gilligan P, Owens N, O'Donnell C (2014) Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment. Int J Emerg Med 7:29. Published 2014 Jul 5
Taqui A, Cerejo R, Itrat A et al (2017) Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis. Neurology 88(14):1305–1312
doi: 10.1212/WNL.0000000000003786
pubmed: 28275084
Geisler F, Kunz A, Winter B et al (2019) Telemedicine in Prehospital Acute Stroke Care. J Am Heart Assoc 8(6):e011729
doi: 10.1161/JAHA.118.011729
pubmed: 30879372
pmcid: 6475065