A Novel Use of Prehospital Telemedicine to Decrease Door to Computed Tomography Results in Acute Strokes

Abstract

Introduction: Timely emergency department (ED) recognition of acute strokes reduces morbidity and mortality and improves outcomes. Prehospital telehealth evaluation rapidly assesses patients with stroke symptoms and mobilizes resources before ED arrival, decreasing ED arrival to computed tomography (CT) result times. Expediting CT results reduces the decision time to determining thrombolytic therapy eligibility. Methods: Seventeen ambulances in our region were supplied with equipment to perform a nonrecordable video examination with an ED physician. Emergency Medical Service requested a physician video examination on patients with a positive prehospital Cincinnati Stroke Scale. The physician and paramedic conducted an NIH-8 scale, and, based on the assessment, the patients were placed directly on the CT scanner table. Results: Four time intervals that impact CT acquisition and thrombolytic decision-making were measured. There was improvement in all time intervals. Time from ED arrival to CT order decreased 1.7 minutes. Time from arrival to study start decreased 5.7 minutes. Time from CT order to result decreased 3.89 minutes and time from ED arrival to CT result decreased 5.6 minutes. Discussion: Prehospital telehealth consults with paramedics, and the receiving hospital for acute strokes significantly decreased times for all metrics studied including the time from ED arrival to CT result.

Application of Telemedicine in the Ambulance for Stroke Patients: A Systematic Review

“…Telemedicine has been used to provide consultations, record and send vital signs and diagnostic tests, as well as interpret the results of CT scans, magnetic resonance imaging/MRI, and ECGs. 12,22–27…”

“…Six studies were conducted in the United States 12,22,23,25–27 and only one study was conducted in Germany. 24 Yang, et al’s study showed that the United States has the highest number of publications and citations in the field of digital health literacy and telemedicine.…”

“…Telemedicine has been used to provide consultations, record and send vital signs and diagnostic tests, as well as interpret the results of CT scans, magnetic resonance imaging/MRI, and ECGs. 12,[22][23][24][25][26][27] Emergency care is an integral part of any care system. Rapid response and treatment with a focus on higher survival rates are the hallmarks of prehospital care systems.…”

“…However, Sarpourian, Ahmadi Marzaleh, Fatemi Aghda, et al multi-team care and solve these problems by improving the quality of communication between rescuers and medical centers, and even dispatching and sharing patient information. 8,36 All seven studies 12,[22][23][24][25][26][27] were conducted in developed countries. It seems that the interest of developed countries in telemedicine is more due to appropriate infrastructure, high computer literacy, and special government laws.…”

“…It seems that the interest of developed countries in telemedicine is more due to appropriate infrastructure, high computer literacy, and special government laws. 16 Six studies were conducted in the United States 12,22,23,[25][26][27] and only one study was conducted in Germany. 24 Yang, et al's study showed that the United States has the highest number of publications and citations in the field of digital health literacy and telemedicine.…”