Telemedicine versus face-to-face evaluation in the delivery of thrombolysis for acute ischaemic stroke: a single centre experience
- Correspondence to Dr Ajay Bhalla, Department of Ageing & Health, Guy's and St Thomas' Hospitals, 9th Floor, North Wing, St Thomas' Hospital, London SE1 7EH, UK;
Contributors AB: original idea for the study, data analysis and co-wrote the paper. MC: data collection, analysis and co-wrote the paper. JB: contributed original work used in the writing of the paper and edited the paper. AR: contributed to discussion and content of Methods and Discussion sections, and edited the paper.
- Received 23 March 2011
- Accepted 16 December 2011
- Published Online First 19 January 2012
Background Telemedicine is increasingly used in the UK to deliver thrombolysis. It is primarily used to enable assessment of people presenting with an acute stroke by a remote specialist in stroke care, and to determine eligibility for thrombolysis with alteplase (recombinant tissue plasminogen activator). This study aims to evaluate the process of acute stroke care, safety and outcome profiles when comparing face-to-face evaluation and telemedicine in the delivery of thrombolysis.
Methods This was a retrospective single centre cohort study, evaluating patients thrombolysed from July 2007 to December 2009 inclusive. All patients were given treatment within a 3-hour window from onset of symptoms. Of the 97 patients thrombolysed, 45 (46%) were evaluated by telemedicine. Process times of the steps taken to deliver thrombolysis for the two groups were compared. The authors include the rates of symptomatic intracranial haemorrhage (SICH). Outcome data include 3-month mortality and functional status.
Results Process times were significantly better in face-to-face: Admission to CT (p=0.001), CT to treatment (p≤0.001) and admission to treatment (p≤0.001). SICH occurred in four patients (7.7%) in the face-to-face group compared with the two patients (4.4%) in the telemedicine group (p=0.7). Favourable outcome: a modified Rankin score of 0–2 was observed in 19 patients (36.5%) in the face-to-face group compared with 19 patients (42%) in the telemedicine group (p=0.9).
Conclusions This analysis shows that the use of telemedicine compared with face-to-face evaluation is feasible in the delivery of thrombolysis during out of hours. There are several areas of our emergency process of hyper-acute stroke care that need improving when using telemedicine.
Competing interests None.
Patient consent This article is related to a process (time data) and patient characteristics that are non-identifiable to specific individuals.
Ethics approval All data regarding patients are non-identifiable, and data were collected retrospectively from patient notes and the stroke database.
Provenance and peer review Not commissioned; externally peer reviewed.