Telestroke in Northern Alberta: A Two Year Experience with Remote Hospitals

Abstract

Stroke is a common neurological emergency and remains a major cause of short and long-term disability worldwide 1 . Thrombolysis with intravenous tissue plasminogen activator (tPA) can result in a significantly better outcome if the treatment is offered early 2 . Despite evidence from several studies showing consistently better results in tPA treated patients, less than 8% of ischemic stroke patients receive intravenous tPA 3,4 . Many factors contribute to the relatively low rate of intravenous tPA treatment. Among them late arrival to a comprehensive stroke centre is a major factor. In the NINDS trial over 16000 stroke victims were screened and among them 50% arrived too late to be treated 5 . Late arrival to hospital is particularly important in countries where the population is spread over a large geographical area.ABSTRACT: Background: Thrombolysis in acute ischemic stroke is usually performed in comprehensive stroke centres. Lack of stroke expertise in remote small hospitals may preclude thrombolysis. Telemedicine allows such management opportunities in distant hospitals. Methods: We report our experience in managing acute stroke over a two-year time period with telestroke. The University of Alberta Hospital acted as the 'hub' and seven remote hospitals as 'spoke'. The neurologist at the 'hub' provided stroke expertise to the local physician using either a two-way video link or telephone. Cranial CT scans were transmitted to 'hub'. Education sessions were held before the initiation of the program. Results: Of 210 patients 44 (21%) received thrombolysis at the 'spoke' sites. In 34/44 (77%) two-way video link was available while in 10/44 (23%) telephone was used. Five (11.4%) patients experienced intracranial hemorrhage after thrombolysis, 2 (4.5%) were symptomatic. Favorable (mRS=0-1) outcome at three months was 16/40 (40%) and mortality was 9/40 (22.5%). Four patients were lost to follow-up. There was no significant three months outcome difference between two-way video link and telephone consultation (P = 0.689). Over two years the number of acute stroke transfers decreased from 144 to 15 at one of the 'spoke' sites, a 92.5% decline. Conclusion: It is possible to successfully treat patients with acute ischemic stroke at remote sites through videoconferencing or telephone consultation. Telestroke can also lead to a significant reduction in the number of patients requiring transfer to a tertiary care centre.RÉSUMÉ: Télé-AVC dans le nord de l'Alberta : une expérience de deux ans dans des hôpitaux situés en région éloignée. Contexte : La thrombolyse dans l'accident vasculaire cérébral (AVC) ischémique aigu est habituellement effectuée dans des centres intégrés de soins de l'AVC. Le manque d'expertise dans le domaine de l'AVC dans les petits hôpitaux situés en région éloignée est un obstacle à la thrombolyse. La télémédecine permet d'y pallier dans les hôpitaux situés en région. Méthodologie : Nous rapportons notre expérience dans la prise en charge de l'AVC aigu au cours d'une période de deux ans au moyen de té...

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