Feasibility of Prehospital Teleconsultation in Acute Stroke – A Pilot Study in Clinical Routine

Abstract

BackgroundInter-hospital teleconsultation improves stroke care. To transfer this concept into the emergency medical service (EMS), the feasibility and effects of prehospital teleconsultation were investigated.Methodology/Principal FindingsTeleconsultation enabling audio communication, real-time video streaming, vital data and still picture transmission was conducted between an ambulance and a teleconsultation center. Pre-notification of the hospital was carried out with a 14-item stroke history checklist via e-mail-to-fax. Beside technical assessments possible influences on prehospital and initial in-hospital time intervals, prehospital diagnostic accuracy and the transfer of stroke specific data were investigated by comparing telemedically assisted prehospital care (telemedicine group) with local regular EMS care (control group). All prehospital stroke patients over a 5-month period were included during weekdays (7.30 a.m. –4.00 p.m.). In 3 of 18 missions partial dropouts of the system occurred; neurological co-evaluation via video transmission was conducted in 12 cases. The stroke checklist was transmitted in 14 cases (78%). Telemedicine group (n = 18) vs. control group (n = 47): Prehospital time intervals were comparable, but in both groups the door to brain imaging times were longer than recommended (median 59.5 vs. 57.5 min, p = 0.6447). The prehospital stroke diagnosis was confirmed in 61% vs. 67%, p = 0.8451. Medians of 14 (IQR 9) vs. 5 (IQR 2) stroke specific items were transferred in written form to the in-hospital setting, p<0.0001. In 3 of 10 vs. 5 of 27 patients with cerebral ischemia thrombolytics were administered, p = 0.655.ConclusionsTeleconsultation was feasible but technical performance and reliability have to be improved. The approach led to better stroke specific information; however, a superiority over regular EMS care was not found and in-hospital time intervals were unacceptably long in both groups. The feasibility of prehospital tele-stroke consultation has future potential to improve emergency care especially when no highly trained personnel are on-scene.Trial RegistrationInternational Standard Randomised Controlled Trial Number Register (ISRCTN) ISRCTN83270177 83270177.

Technical Support by Smart Glasses During a Mass Casualty Incident: A Randomized Controlled Simulation Trial on Technically Assisted Triage and Telemedical App Use in Disaster Medicine (Preprint)

“…The much better quality of triage is certainly also due to the high level of compliance with the guidelines for the processing of the screening algorithm as well as other procedural instructions. This phenomenon is also indicated by other studies of individual medical treatments by the tele-EMS physician in Aachen Germany (Bergrath et al, 2012).…”

A low-cost, tablet-based option for prehospital neurologic assessment

“…Although promising, these pilot studies demonstrated technical challenges including earlier-generation broadband, limiting technical feasibility. [8][9][10] More recent studies incorporating modern cellular connectivity have shown greater reliability but involve costly telemedicine endpoints and a limited geographic scope primarily confined to urban areas. 11,12 The objective of our study, Improving Treatment with Rapid Evaluation of Acute Stroke via Mobile Telemedicine (iTREAT), is to demonstrate the reliability and technical feasibility of bidirectional, ambulance-based videoconferencing using a low cost, portable mobile telestroke system.…”

“…8 More recent mobile telestroke demonstrations in Europe have shown conflicting but promising feasibility results, highlighting the importance of 4G vs 3G mobile broadband to achieve reliable continuous connectivity for uninterrupted communication. [9][10][11] In the United States, investigators in Houston, TX, reported successful feasibility and reliability of telemedicine in a mobile stroke unit using the RPXpress portable telemedicine system from InTouch Technologies, Inc. (Santa Barbara, CA). 12 Similar to our study, they utilized patient actors performing simulated stroke scenarios during ambulance transport and were able to demonstrate excellent intraclass correlation (0.997, 0.97-0.998) for the NIHSS score between real-time and scripted scenarios.…”

Prehospital stroke care

“…Telemedicine with video examination of stroke patients in ambulances for earlier stroke recognition has been reported in 2 recent studies. 32,33 While TeleStroke assessment appears feasible in general and has become routine care in many hospitals, 34 data transmission based on the third-generation mobile communication technology currently available was not stable enough for routine use in the prehospital setting. 33 The increasingly available fourth-generation technology is being tested in several regions and may offer major advantages by higher bandwidth (particularly in the upload stream) and by prioritizatized connection.…”