Telemedicine enables better stroke treatment decisions

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A telemedicine program that transmits data from a patient's bedside to stroke specialists, utilizing audio and video technology via the Internet, could positively impact the treatment of stroke patients, according to a study published online this week in Lancet Neurology.

Brett C. Meyer, MD, principal investigator of the five-year STRokE DOC trial and co-director of the University of California, San Diego (UCSD) Medical Center Stroke Center, and colleagues investigated the use of a site-independent telemedicine system when used to provide remote consultation leading to treatment decisions about stroke patients. The study was designed to determine if the STRokE DOC technology enabled physicians to make good treatment decisions—better than telephone consultations—in evaluating stroke patients across distant sites.

STRokE DOC (Stroke Team Remote Evaluation using a Digital Observation Camera) connects stroke experts at a ‘hub’ site to the patient at a remote, but connected, ‘spoke’ site via the internet. The audio/video teleconsultation system allows the stroke expert real-time visual and audio access to the patient, medical team and medical data at the remote site, the authors wrote.

The results of 222 patient cases showed that telemedicine evaluation led to better decision-making than telephone consultations, according to the researchers.

“Using STRokE DOC, our stroke team physicians were able to evaluate the patient and help make the correct decision about treatment over 98 percent of the time, compared to only 82 percent of the time when doing a telephone consultation to a remote site,” said Meyer, who is an associate professor of neurosciences at the UCSD School of Medicine.

UCSD stroke team doctors can access the telemedicine system—pioneered at UCSD in collaboration with the California Institute for Telecommunications and Information Technology, Qualcomm and BF-Technologies—from any location with the internet, enabling them to rapidly connect with an emergency medicine practitioner, the patient or their family members at the ‘spoke.’ A mobile camera server with an intravenous-pole design is placed at the foot of the patient’s bed at the remote site.

Via the system, the stroke specialists can speak to the patient, family members, nurses and attending physicians, as well as directly view CT scan images of the patient’s brain. In turn, patients and their families can and communicate directly with the stroke expert, according to Meyer and colleagues.

"Rural physicians can now provide much needed specialty care to their patients via telemedicine," said George Rodriguez, MD, of El Centro Regional Medical Center in California, a rural community partner with UCSD in its STRokE DOC program and a participating ‘spoke’ hospital in the clinical trial.  

The UCSD researchers said that the next step is a study to evaluate the long-term health outcomes of patients. “What this study tells us is that we need a bigger trial to determine the difference – if any – in clinical outcomes for these patients,” Meyer and colleagues concluded.

The National Institutes of Health funded the study.