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Medical centers having access to stroke specialists are transmitting their expertise to rural communities via audio/video telemedicine consultation, with clinical results, according to a study.

The study, Pooled Analysis of the STRokE DOC and STRokE DOC-AZ Telemedicine Stroke Trials, followed two primary "hub" stroke centers — Mayo Clinic in Arizona and the University of California, San Diego — and six rural "spoke" hospitals. Results support the hypothesis that compared with telephone consultations, telemedicine evaluation of stroke patients results in more accurate diagnoses, better emergency decision-making, fewer complications and encouraging long-term outcomes. STRokE DOC (Stroke Team Remote Evaluation using a Digital Observation Camera) connects stroke specialists at the hub site to a remote spoke site, using an internet connection.

The 276 patients exhibiting symptoms of stroke at their respective emergency departments were randomly assigned to telephone consultations versus two-way telemedicine consultations using a digital observation camera.

Results of the five-year study showed that the correct emergency stroke treatment decision-making was made 96 percent of the time with the audio/video telemedicine technology, compared with 83 percent for telephone only. Importantly, diagnosis by telemedicine means that use of clot-busting medications for stroke can be increased to 29 percent, noting that one in three acute stroke patients are able to receive disability-reducing emergency clot-busting medications. Previously, fewer than 5 percent of patients in the rural communities had access to such treatments.

The process of stroke telemedicine goes like this: A call is placed from one of the remote "spoke" rural hospitals to one of the "hub" medical centers. The hub vascular neurologist is equipped with a "telemedicine tool belt," including a smart phone with a teleradiology application and other technology such as a laptop with a web cam. The remote, spoke hospital is equipped with a mobile robot telemedicine camera system that is positioned near the patient's bed. From afar, the stroke physician can observe and speak with the patient, and health care providers do a real-time consultation and review CT scans of the brain. If a diagnosis of stroke is confirmed, appropriate treatment can be quickly administered, such as a clot-busting drug when a clot is blocking blood flow to the brain.

"Results of this trial are significant, in that they confirm the effectiveness of telemedicine as a tool to evaluate acute stroke. This leads to appropriate decisions on behalf of patients — timely treatment, low complication rates and good long-term outcomes," says Bart Demaerschalk, M.D., Mayo Clinic neurologist and principal investigator of the Arizona trial.

Source :Mayo Clinic

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