• J Stroke Cerebrovasc Dis · May 2013

    Comparative Study

    Impact of telemedicine implementation in thrombolytic use for acute ischemic stroke: the University of Pittsburgh Medical Center telestroke network experience.

    • Edilberto Amorim, Min-Mei Shih, Steven A Koehler, Lori L Massaro, Syed F Zaidi, Mouhammad A Jumaa, Vivek K Reddy, Maxim D Hammer, Tudor G Jovin, and Lawrence R Wechsler.
    • Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
    • J Stroke Cerebrovasc Dis. 2013 May 1;22(4):527-31.

    BackgroundIntravenous thrombolysis is the only therapy for acute ischemic stroke that is approved by the US Food and Drug Association. The use of telemedicine in stroke makes it possible to bring the expertise of academic stroke centers to underserved areas, potentially increasing the quality of stroke care.MethodsAll consecutive admissions for stroke were reviewed for 1 year before telemedicine implementation and for variable periods thereafter. A retrospective review identified 2588 admissions for acute stroke between March 2005 and December 2008 at 12 hospitals participating in a telestroke network, including 919 patients before telemedicine was available and 1669 patients after telemedicine was available. The primary outcome measure was the rate of intravenous tissue plasminogen activator (IV tPA) use before and after telemedicine implementation.ResultsOne hundred thirty-nine patients received IV tPA in both study phases, with 26 (2.8%) patients treated before starting telemedicine and 113 (6.8%) after starting telemedicine (P < .001). Incorrect treatment decisions occurred 7 times (0.39%), with 2 (0.2%) pretelemedicine and 5 (0.3%) posttelemedicine (P = .70). Arrivals within 3 hours from symptom onset were more frequent in the posttelemedicine compared to the pretelemedicine phases (55 [6%] vs 159 [9.5%]; P = .002). Among the patients treated with IV tPA, symptomatic intracranial hemorrhage occurred in 2 patients (1 [10.7%] pretelemedicine vs 1 [1.8%] posttelemedicine; P = .34).ConclusionsTelestroke implementation was associated with an increased rate of thrombolytic use in remote hospitals within the telemedicine network.Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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