Telestroke in an urban setting.

ABSTRACT

BACKGROUND: Telestroke is a viable alternative in rural areas where neurologists or stroke expertise is unavailable. Urban applications of telestroke have not been previously described. MATERIALS AND METHODS: All patients evaluated using remote telestroke technology at four urban spoke hospitals between March 2011 and March 2013 were included in this analysis. Telestroke services were provided by vascular fellowship-trained neurologists at one academic stroke center. Patient characteristics, time to initiation of consult, and treatment decisions were prospectively recorded. Stroke triage protocols and thrombolysis rates prior to initiation of telestroke were also obtained. RESULTS: Four hundred ninety-eight patients were evaluated during the study period; mean age was 64.5 years, and 60.4% were female. Median time from initial emergency room call to start of teleconsult was 5 (range, 1-51) minutes. Average length of teleconsult was 30 minutes. Technical difficulties occurred in 80 (16.0%) teleconsults, but only 1 was major. Daytime calls (8 a.m.-5 p.m. Monday-Friday) accounted for 38.2% of teleconsults. Two hundred eighty-one patients (56.4%) were determined by teleconsult to have an acute ischemic stroke or transient ischemic attack (TIA). In 72 patients (14.5% overall; 25.6% of all ischemic stroke/TIA patients), intravenous alteplase (tissue plasminogen activator) was recommended. Transfer to the hub hospital occurred in 75 patients (15.1%). CONCLUSIONS: Telestroke is a rapid and effective way to assess patients with suspected acute stroke in an urban setting. Its use may increase access to stroke neurologists and improve thrombolysis rates where competing responsibilities may delay, prevent, and even dissuade on-site evaluation by neurologists.