Telestroke—the promise and the challenge. Part one: growth and current practice

Akbik, Feras; Hirsch, Joshua A; Chandra, Ronil V.; Frei, Don; Patel, Aman B.; Rabinov, James D.; Rost, Natalia S.; Schwamm, Lee H; Leslie‐Mazwi, Thabele M

doi:10.1136/neurintsurg-2016-012291

Cited by 52 publications

(36 citation statements)

References 84 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, LVO scales are increasingly used to render decisions regarding immediate patient transfer to EST capable hospitals when LVO is suspected, 13,21-23 including in the setting of telemedicine consultations. 24 In this setting our results may be impactful when a plain head CT is reviewed (and provide information on leukoaraiosis severity) but no CTA obtained due to lack of resources, immediate availability, or because it is undesirable to avoid repeat imaging at the EST-capable hub hospital. 25,26 Leukoaraiosis has been repeatedly shown to confer an increased risk for poor outcome in LVO patients including those undergoing EST.…”

Section: Discussionmentioning

confidence: 97%

Leukoaraiosis Attenuates Diagnostic Accuracy of Large-Vessel Occlusion Scales

Mayasi

Goddeau

Moonis

et al. 2017

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

Background and purpose Pre-hospital stroke scales may help identify patients likely to have large vessel occlusion (LVO) to facilitate rapid triage to thrombectomy-capable stroke centers. Scale misclassification may result in inaccurate decisions and possible harm. Pre-existing leukoaraiosis has been shown to attenuate the association between deficit type and stroke severity. We sought to determine whether leukoaraiosis affects the predictive ability of 5 commonly used LVO scales. Materials and Methods We retrospectively analyzed 274 consecutive stroke patients with available brain MRI and vessel imaging. The following LVO scales were used: 3 Item Stroke Scale (3I/SS), Field Assessment Stroke Triage for Emergency Destination (FAST-ED), Rapid Arterial Occlusion Evaluation (RACE), Vision, Aphasia, Neglect (VAN) score, and Cincinnati Pre-hospital Stroke Severity Scale (CPSSS). For diagnostic scale accuracy, we assessed sensitivity, specificity, positive predictive value, negative predictive value, and kappa. Multivariable logistic regression was used to determine the scales' predictive ability after adjustment for leukoaraiosis and potential confounders. Results In unadjusted analyses, all scales predicted the presence of LVO (n=46; P<0.01, each); though diagnostic accuracy was attenuated among patients with moderate-to-severe leukoaraiosis. After adjustment, the FAST-ED (OR 3.2 [1.1-9.5]; P=0.033), and RACE (OR 3.7 [1.3-10.8]; P=0.015) but not 3I/SS (OR 5.4 [0.86-33.9]); P=0.073), VAN (OR 2.5 [0.8-7.2]), and CPSSS (OR 2.8 [1.0-8.0]) predicted LVO. Conclusion The diagnostic accuracy of the tested LVO scales was attenuated in the presence of moderate-to-severe leukoaraiosis. This information that may aid the design of future studies that require LVO scale screening of patients that are likely to have concomitant leukoaraiosis.

show abstract

Section: Discussionmentioning

confidence: 97%

Leukoaraiosis Attenuates Diagnostic Accuracy of Large-Vessel Occlusion Scales

Mayasi

Goddeau

Moonis

et al. 2017

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…These issues can however be mitigated as technology expands to the more rural regions and licensing becomes easier to acquire as the application of telemedicine and telestroke continues to expand. 22 program was however shut down due to funding costs. A similar study conducted by Breslow et.…”

Section: Telemedicine In the Icumentioning

confidence: 99%

Commentary: Tele-ICU Development and Application

DeJesus¹,

Athar²

2017

JHN Journal

View full text Add to dashboard Cite

“…Other non-nephrology telemedicine services using real-time monitoring have been implemented in hospital settings such as tele-stroke and tele-ICU which have shown positive health outcomes (10)(11). In addition, telemedicine interventions decreased overall mortality and length of stay (LOS) within progressive care units in a large hospital system without substantial cost incurrences (12).…”

Section: Introductionmentioning

confidence: 99%