Introduction of Portable Computed Tomography Scanners, in the Treatment of Acute Stroke Patients via Telemedicine in Remote Communities

Shuaib, Ashfaq; Khan, Khurshid; Whittaker, T.; Amlani, Shy; Crumley, P.

doi:10.1111/j.1747-4949.2010.00408.x

Cited by 24 publications

(23 citation statements)

References 6 publications

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“…[127][128][129] Although telemedicine including video examination equipment is mentioned, it remains unclear how many patients treated with tPA were remotely assessed in the latter studies. Mortality at 90 days has been reported in a limited number of cohorts of uncontrolled studies and reports, 93,116 comparisons between telemedicine-guided thrombolysis and in-person-initiated thrombolysis, 99,119,124 an observational study of telephone versus telemedicine thrombolysis, 91 and 2 randomized controlled trials. 5,136 Longer-term mortality after thrombolysis by telestroke has been described for unselected stroke patients in an uncontrolled study, 117 pretelestroke/posttelestroke implementation evaluations, 131,137 and a comparison of hospitals within a telestroke unit network and matched conventional hospitals, 134,135 as well as 1 randomized controlled trial.…”

Section: Mortalitymentioning

confidence: 99%

“…Some telemedicine studies do not provide a specific definition. Rates of symptomatic intracranial hemorrhages were reported in uncontrolled telestroke studies, 15,35,42,[114][115][116][117][118] pretelestroke/posttelestroke implementation evaluations, 10,119 and comparisons between remote-and on-site-initiated thrombolysis 36,88,93,[120][121][122][123][124][125][126] and telephone and telemedicine (video assessment based) thrombolysis. 36 Two randomized controlled trials report intracerebral hemorrhage rates without specific definition.…”

Section: Intracranial Hemorrhagementioning

confidence: 99%

See 1 more Smart Citation

Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Wechsler¹,

Demaerschalk²,

Schwamm³

et al. 2017

Stroke

215

155

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e3T elestroke is one of the most successful applications of telemedicine, bringing the experience of stroke experts to hospitals lacking appropriate stroke expertise. The number and extent of telestroke networks continue to grow in the United States and throughout the world. As telestroke matures, monitoring practice quality and outcomes becomes essential to Purpose-Telestroke is one of the most frequently used and rapidly expanding applications of telemedicine, delivering much-needed stroke expertise to hospitals and patients. This document reviews the current status of telestroke and suggests measures for ongoing quality and outcome monitoring to improve performance and to enhance delivery of care. Methods-A literature search was undertaken to examine the current status of telestroke and relevant quality indicators.The members of the writing committee contributed to the review of specific quality and outcome measures with specific suggestions for metrics in telestroke networks. The drafts were circulated and revised by all committee members, and suggestions were discussed for consensus. Results-Models of telestroke and the role of telestroke in stroke systems of care are reviewed. A brief description of the science of quality monitoring and prior experience in quality measures for stroke is provided. Process measures, outcomes, tissue-type plasminogen activator use, patient and provider satisfaction, and telestroke technology are reviewed, and suggestions are provided for quality metrics. Additional topics include licensing, credentialing, training, and documentation. (Stroke. 2017;48:e3-e25.

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Section: Mortalitymentioning

confidence: 99%

Section: Intracranial Hemorrhagementioning

confidence: 99%

Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Wechsler¹,

Demaerschalk²,

Schwamm³

et al. 2017

Stroke

215

155

View full text Add to dashboard Cite

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“…In another study [4], the accuracy of ischemic stroke diagnosis (by radiographic confirmation) was similar between patients receiving IV rt-PA through primary ED arrival or the drip-and-ship paradigm. Rapid acquisition of CT scan images at referring EDs and remote expert interpretation have also favorably impacted the drip-and-ship paradigm [11]. Many referral hospitals initiate IV rt-PA using telemedicine or telephone consultation before transferring patients to a regional stroke center and, therefore, acquire guidance from stroke specialists in a time-efficient manner.…”

Section: Discussionmentioning

confidence: 99%

Outcome of the ‘Drip-and-Ship’ Paradigm among Patients with Acute Ischemic Stroke: Results of a Statewide Study

Qureshi

Chaudhry

Rodríguez

et al. 2012

Cerebrovasc Dis Extra

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Background: The ‘drip-and-ship’ paradigm denotes a treatment regimen in patients in whom intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is initiated at the emergency department (ED) of a community hospital, followed by transfer within 24 h to a comprehensive stroke center. Although the drip-and-ship paradigm has the potential to increase the number of patients who receive IV rt-PA, comparative outcomes have not been assessed at a population-based level. Methods: Statewide estimates of thrombolysis, associated in-hospital outcomes, and hospitalization charges were obtained from 2008–2009 Minnesota Hospital Association data for all patients hospitalized with a primary diagnosis of ischemic stroke. Patients who were assigned the drip-and-ship code [International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) V45.88] were classified under the drip-and-ship paradigm. Patients who underwent thrombolysis (ICD-9-CM code 99.10) without drip-and-ship code were classified as primary ED arrival. Patient outcomes were analyzed after stratification into patients treated with IV rt-PA through primary ED arrival or drip-and-ship paradigm. Results: Of the 21,024 admissions, 602 (2.86%) received IV rt-PA either through primary ED arrival (n = 473) or the drip-and-ship paradigm (n = 129). IV rt-PA was administered in 30 hospitals, of which 13 hospitals used the drip-and-ship paradigm; the number of patients treated with the drip-and-ship paradigm varied from 1 to 40 between the 13 hospitals. The rates of secondary intracerebral or subarachnoid hemorrhage were higher in patients treated with IV rt-PA through primary ED arrival compared with those treated with the drip-and-ship paradigm (8.5 vs. 3.1%, respectively; p = 0.038). The in-hospital mortality rate was similar among ischemic stroke patients receiving IV rt-PA through primary ED arrival or the drip-and-ship paradigm (5.9 vs. 7.0%, respectively). The mean hospital charges were USD 65,669 for primary ED arrival and USD 47,850 for drip-and-ship-treated patients (p < 0.001). The rate of admission to a certified stroke center as final destination for acute hospitalization was higher in patients treated by drip-and-ship paradigm compared with those treated by primary ED arrival mode (p = 0.015). Conclusions: The results of the drip-and-ship paradigm compare favorably with IV rt-PA treatment through primary ED arrival in this statewide study. Our results support the recommendations of various professional organizations that the drip-and-ship method of IV rt-PA administration for stroke may be an effective option for increasing the utilization of IV rt-PA on a large scale.

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“…The dimensions are: height, 144 mm; length, 148 mm; width 258 mm, without the skin guard or hand strap. [2][3][4][5] However, there have been no reports of X-ray studies using portable X-ray systems under transportation by a physician-staffed helicopter in a prehospital setting. The system requires a special cassette and notebook-type personal computer to operate and display Xray images (Fig.…”

Section: Introductionmentioning

confidence: 99%

Experience using a portable X‐ray system at the scene transported by a physician‐staffed helicopter

Omori

Yanagawa

Muramatsu

et al. 2019

Acute Medicine & Surgery

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Background Fujifilm (Tokyo, Japan) developed a portable X‐ray system called the CALNEO Xair, which can be carried by a physician. The X‐ray radiation machine weighs 3.5 kg. The dimensions are: height, 144 mm; length, 148 mm; width, 258 mm. Case Presentation When a 33‐year‐old woman driving a car made a right turn at a crossroad, her car hit another car, causing her vehicle to tip onto its side. Staff of the doctor helicopter checked her at the scene, and the findings of chest and pelvic X‐ray were all negative. She received a diagnosis of cervical sprain and pelvic contusion and was transferred to a local hospital by ambulance. Conclusion This is the first report of a case evaluated by a portable X‐ray system at the scene, under transportation by a doctor helicopter. This system could be useful for undertaking prehospital assessment and medical treatment.

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Introduction of Portable Computed Tomography Scanners, in the Treatment of Acute Stroke Patients via Telemedicine in Remote Communities

Cited by 24 publications

References 6 publications

Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Outcome of the ‘Drip-and-Ship’ Paradigm among Patients with Acute Ischemic Stroke: Results of a Statewide Study

Experience using a portable X‐ray system at the scene transported by a physician‐staffed helicopter

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