Efficacy of telemedicine for stroke: pooled analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona telestroke trials.
Telemed J E Health
; 18(3): 230-7, 2012 Apr.
Article
em En
| MEDLINE
| ID: mdl-22400970
ABSTRACT
BACKGROUND AND PURPOSE:
Telemedicine can disseminate vascular neurology expertise and optimize recombinant tissue plasminogen activator (rt-PA) use for acute ischemic stroke in rural underserved communities. The purpose of this study was to prospectively assess whether telemedicine or telephone was superior for decision-making.METHODS:
The study design is a pooled analysis of two identically designed randomized controlled trials conducted in a multistate hub and spoke telestroke network setting with acute stroke syndrome patients, comparing telemedicine versus telephone-only consultations. From each trial, common data elements were pooled to assess, principally, for correctness of thrombolysis decision-making. Secondary outcomes included rt-PA use rate, 90-day functional outcome, post-thrombolysis intracranial hemorrhage, and data completeness.RESULTS:
Two hundred seventy-six pooled patients were evaluated. Correct thrombolysis eligibility decisions were made more often with telemedicine (96% telemedicine, 83% telephone; odds ratio [OR] 4.2; 95% confidence interval [CI] 1.69-10.46; p=0.002). Intravenous rt-PA usage was 26% (29% telemedicine, 24% telephone; OR 1.27; 95% CI 0.71-2.25; p=0.41). Ninety-day outcomes were not different for Barthel Index, modified Rankin Scale, or mortality. There was no difference in post-thrombolysis intracranial hemorrhage (8% telemedicine, 6% telephone; p>0.999).CONCLUSIONS:
This pooled analysis supports the hypothesis that stroke telemedicine consultations, compared with telephone-only, result in more accurate decision-making. Together with high rt-PA utilization rate, low post-rt-PA intracranial hemorrhage rate, and acceptable patient outcome, the results confirm that telemedicine is a viable consultative tool for acute stroke. The replication of the hub and spoke network infrastructure supports the generalizability of telemedicine when used in broader settings.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Telefone
/
Hospitais Rurais
/
Ativador de Plasminogênio Tecidual
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Telemedicina
/
Acidente Vascular Cerebral
Tipo de estudo:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Telemed J E Health
Assunto da revista:
INFORMATICA MEDICA
/
SERVICOS DE SAUDE
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Estados Unidos