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

Wechsler, Lawrence R.; Demaerschalk, Bart M.; Schwamm, Lee H; Adeoye, Opeolu; Audebert, Heinrich J.; Fanale, Christopher; Hess, David C.; Majersik, Jennifer J.; Nyström, Karin; Reeves, Mathew J.; Rosamond, Wayne D.; Switzer, Jeffrey A.

doi:10.1161/str.0000000000000114

Cited by 214 publications

(165 citation statements)

References 162 publications

(207 reference statements)

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“…However, our work has some limitations. First, we have no data on patients and relatives' satisfaction attended through the telestroke system, as recommended by the AHA/ASA guidelines [11]. Secondly, we do not have data on reasons for excluding thrombectomy at CSC among those considered candidates at Tele-SC (i.e., absence of vessel occlusion, neuroimaging criteria) and we did not register important time metrics as door-in-door-out or times in Tele-SC.…”

Section: Discussionmentioning

confidence: 98%

Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers

et al. 2018

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Objectives: The study aimed to evaluate the impact of a telestroke network on acute stroke care in Catalonia, by measuring thrombolysis rates, access to endovascular treatment, and clinical outcome of telestroke patients in a population-based study. Methods: Telestroke network was implemented on March 2013 and consists of 12 community hospitals and 1 expert stroke neurologist 24 h/7 day, covering a population of 1.3 million inhabitants. Rest of the population (6.2 million) of Catalonia is covered by 8 primary stroke centers (PSC) and 6 comprehensive stroke centers (CSC). After a 2-way videoconference and visualization of neuroimaging on a web platform, the stroke neurologist decides the therapeutic approach and/or to transfer the patient to another facility, entering these data in a mandatory registry. Simultaneously, all patients treated with reperfusion therapies in all centers of Catalonia are prospectively recorded in a mandatory and audited registry. Results: From March 2013 to December 2015, 1,206 patients were assessed by telestroke videoconference, of whom 322 received intravenous thrombolysis (IVT; 33.8% of ischemic strokes). Baseline and 24 h NIHSS, rate of symptomatic hemorrhage, mortality, and good outcome at 3 months were similar compared to those who received IVT in PSC or CSC (2,897 patients in the same period). The door-to-needle time was longer in patients treated through telestroke, but was progressively reduced from 2013 to 2015. Percentage of patients receiving thrombectomy after IVT was similar in patients treated through telestroke circuit, compared to those treated in PSC or CSC (conventional circuit). Population rates of IVT*100,000 inhabitants in Catalonia increased from 2011 to 2015, especially in areas affected by the implementation of telestroke network, achieving rates as high as 16 per 100,000 inhabitants. Transfers to another facility were avoided after telestroke consultation in 46.8% of ischemic, 76.5% of transient ischemic attacks, and 23.5% of hemorrhages. Conclusions: Telestroke favors safe and effective thrombolysis, helps to increase the population rate of IVT, and avoids a large number of interhospital transfers.

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Section: Discussionmentioning

confidence: 98%

Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers

et al. 2018

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“…Our hospital telemedicine system fits modern statement in general [11]. Remote examination of patients was performed using a videoconferencing unit (Cisco TelePresence SX20, Cisco systems, USA) and Edge75 MXP (Tandberg, Norway) fixed set with a remote camera control.…”

Section: Methodsmentioning

confidence: 99%

A Comparison of Remote and Bedside Assessment of the National Institute of Health Stroke Scale in Acute Stroke Patients

Алашеев¹,

Andreev²,

Gonysheva³

et al. 2017

Eur Neurol

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Introduction: Telestroke videoconference for conducting the National Institute of Health Stroke Scale (NIHSS) is recommended when the facility of a direct bedside evaluation by a stroke specialist is not immediately available for hyperacute stroke assessment. However, some NIHSS-telestroke studies inherit systematic bias due to the subjective nature of NIHSS administration. We aimed to evaluate NIHSS telestroke assessment, while implementing measures to minimize subjectivity bias. Patients and Methods: Ninety stroke patients within 48 h of onset were assessed by 6 stroke neurologists grouped in 15 pairs. Each pair of physicians assessed 6 patients. Patients were allocated through block randomization to a physician pair and order of bedside or remote assessment. Every patient was assessed once at the bedside and once remotely. Remote examination was performed by a neurologist through high-quality videoconferencing (HQ-VTC), assisted by a nurse at the patient's bedside. Kappa coefficients and the number of patients with a cumulative difference of ≤3 NIHSS points were calculated to compare bedside and remote measures. Results: Cumulative difference of ≤3 NIHSS points was observed in 85.6% (95% CI 76.6-92.1%) cases. Therefore, every fifth remote examination may have been inaccurate. Quadratically weighted kappa for total NIHSS score was 0.91 (95% CI 0.87-0.95). Minimal agreements were for commands (k = 0.46), facial palsy (k = 0.43), and ataxia (k = 0.27). Remote assessments were longer than bedside: 8 min (interquartile range, IQR 7-9) vs. 6 (IQR 5-8), p < 0.001. Conclusions: NIHSS-telestroke assessment using HQ-VTC in the acute stroke settings is closely matched with NIHSS-bedside assessment but it's credibility for clinical use needs further evaluation.

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“…It is convenient and saves time for the patient and high patient satisfaction rates have been found. Health care services like telepsychology [35] are relatively commonplace and telemedicine used in the group of patients suffering sequelae after stroke [6] is routinely used in rural hospitals. Moreover, insurance carriers are realizing the benefits of telehealth and it is being frequently reimbursed.…”

Section: Future Recommendations For Telescimentioning

confidence: 99%

“…Telemedicine was used as early as in the 1930s for telephone consultations for passengers on the Queen Mary [3]. Recently, the use of telemedicine has expanded rapidly with services available directly to patient for common concerns, such as upper respiratory and urinary tract infections [4] and through consultation from healthcare facilities for issues such as diabetic retinopathy [5], acute stroke [6] and intensive care unit patient management [7].…”

Section: Introductionmentioning

confidence: 99%

Telehealth for people with spinal cord injury: a narrative review

et al. 2018

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Study design Narrative review. Objectives To find and discuss what has been published about the use of telehealth, on people with spinal cord injury (teleSCI). Setting International. Method Cochrane Library, Ovid Medline, EMBASE and CINAHL, from 1996 till June 2017 have been searched. Searches in PsycINFO, from 1996 till September 2017, were included afterwards. Extracted data include studies in English language, containing information about spinal cord injury and disorders, and telehealth. Literature reviews, systematic reviews, and studies containing other types of neurological disorders, were excluded. Studies were grouped based on how and to whom telehealth was offered.Results Twenty nine studies were included in the review. They were categorized according to the way teleSCI was provided, and to what modality was used. Some studies utilized more than one modality. TeleSCI seems to be favorable concerning treatment and follow-up, as well as favorable socioeconomically and environmentally. The studies spanned across several aims and outcomes. There was also heterogeneity in number of participants, the differences in modalities, and in the level of evidence. Thus it was challenging to compare studies and make future recommendations. Conclusions TeleSCI can be used for examination and guiding purposes. Further research is warranted to evaluate optimal utilization, methodology and efficacy. Sponsorship The first author has received funding from the Norwegian Extra Foundation.

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

Cited by 214 publications

References 162 publications

Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers

Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers

A Comparison of Remote and Bedside Assessment of the National Institute of Health Stroke Scale in Acute Stroke Patients

Telehealth for people with spinal cord injury: a narrative review

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