A Web-based Telestroke System Facilitates Rapid Treatment of Acute Ischemic Stroke Patients in Rural Emergency Departments

Jeffrey A Switzer, Christiana Hall, Hartmut Gross, Jennifer L Waller, Fenwick T Nichols, Sam Wang, Robert J. Adams, David C Hess

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Patients in rural communities lack access to acute stroke therapies. Rapid administration of thrombolytic therapy increases the likelihood of a favorable outcome in ischemic stroke. We aimed to detail the safety, feasibility, and treatment times of thrombolytic therapy with a web-based telestroke system. At the Medical College of Georgia, we have developed a telestroke system (Remote Evaluation of Acute IsCHemic Stroke; REACH) in which emergency physicians in surrounding counties may consult stroke specialists at our institution. The web-based system allows the stroke consultant to obtain history, examine the patient with live video, and review computed tomography. A recommendation is made regarding the administration of tissue plasminogen activator (tPA) before patient transport to the tertiary medical center. A systematic review of the literature was conducted regarding the use of tPA in academic and community hospitals. Symptomatic hemorrhagic transformation and stroke onset-to-treatment times were compared between the REACH network and other stroke care delivery systems. Between February 2003 and March 2006, 50 patients were treated with intravenous tPA using the REACH telestroke system. There was one (2%) symptomatic hemorrhage. The mean onset-to-treatment time was 127.6 min (95% confidence interval 117.1-138.0) using REACH compared with 145.9 min (95% confidence interval 126.9-164.9) in our Emergency Department and 147.8 min in other published systems. REACH, a web-based telestroke system, facilitates the safe administration of thrombolytic therapy to patients within rural communities suffering an acute ischemic stroke.

Original languageEnglish (US)
Pages (from-to)12-18
Number of pages7
JournalJournal of Emergency Medicine
Volume36
Issue number1
DOIs
StatePublished - Jan 1 2009

Fingerprint

Hospital Emergency Service
Stroke
Thrombolytic Therapy
Tissue Plasminogen Activator
Rural Population
Therapeutics
Confidence Intervals
Community Hospital
Consultants
Emergencies
History
Tomography
Hemorrhage
Physicians
Safety

Keywords

  • cerebrovascular accident
  • rural hospitals
  • telemedicine
  • thrombolytic therapy

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{d12f04310afc4274a8413527c30b46ce,
title = "A Web-based Telestroke System Facilitates Rapid Treatment of Acute Ischemic Stroke Patients in Rural Emergency Departments",
abstract = "Patients in rural communities lack access to acute stroke therapies. Rapid administration of thrombolytic therapy increases the likelihood of a favorable outcome in ischemic stroke. We aimed to detail the safety, feasibility, and treatment times of thrombolytic therapy with a web-based telestroke system. At the Medical College of Georgia, we have developed a telestroke system (Remote Evaluation of Acute IsCHemic Stroke; REACH) in which emergency physicians in surrounding counties may consult stroke specialists at our institution. The web-based system allows the stroke consultant to obtain history, examine the patient with live video, and review computed tomography. A recommendation is made regarding the administration of tissue plasminogen activator (tPA) before patient transport to the tertiary medical center. A systematic review of the literature was conducted regarding the use of tPA in academic and community hospitals. Symptomatic hemorrhagic transformation and stroke onset-to-treatment times were compared between the REACH network and other stroke care delivery systems. Between February 2003 and March 2006, 50 patients were treated with intravenous tPA using the REACH telestroke system. There was one (2{\%}) symptomatic hemorrhage. The mean onset-to-treatment time was 127.6 min (95{\%} confidence interval 117.1-138.0) using REACH compared with 145.9 min (95{\%} confidence interval 126.9-164.9) in our Emergency Department and 147.8 min in other published systems. REACH, a web-based telestroke system, facilitates the safe administration of thrombolytic therapy to patients within rural communities suffering an acute ischemic stroke.",
keywords = "cerebrovascular accident, rural hospitals, telemedicine, thrombolytic therapy",
author = "Switzer, {Jeffrey A} and Christiana Hall and Hartmut Gross and Waller, {Jennifer L} and Nichols, {Fenwick T} and Sam Wang and Adams, {Robert J.} and Hess, {David C}",
year = "2009",
month = "1",
day = "1",
doi = "10.1016/j.jemermed.2007.06.041",
language = "English (US)",
volume = "36",
pages = "12--18",
journal = "Journal of Emergency Medicine",
issn = "0736-4679",
publisher = "Elsevier USA",
number = "1",

}

TY - JOUR

T1 - A Web-based Telestroke System Facilitates Rapid Treatment of Acute Ischemic Stroke Patients in Rural Emergency Departments

AU - Switzer, Jeffrey A

AU - Hall, Christiana

AU - Gross, Hartmut

AU - Waller, Jennifer L

AU - Nichols, Fenwick T

AU - Wang, Sam

AU - Adams, Robert J.

AU - Hess, David C

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Patients in rural communities lack access to acute stroke therapies. Rapid administration of thrombolytic therapy increases the likelihood of a favorable outcome in ischemic stroke. We aimed to detail the safety, feasibility, and treatment times of thrombolytic therapy with a web-based telestroke system. At the Medical College of Georgia, we have developed a telestroke system (Remote Evaluation of Acute IsCHemic Stroke; REACH) in which emergency physicians in surrounding counties may consult stroke specialists at our institution. The web-based system allows the stroke consultant to obtain history, examine the patient with live video, and review computed tomography. A recommendation is made regarding the administration of tissue plasminogen activator (tPA) before patient transport to the tertiary medical center. A systematic review of the literature was conducted regarding the use of tPA in academic and community hospitals. Symptomatic hemorrhagic transformation and stroke onset-to-treatment times were compared between the REACH network and other stroke care delivery systems. Between February 2003 and March 2006, 50 patients were treated with intravenous tPA using the REACH telestroke system. There was one (2%) symptomatic hemorrhage. The mean onset-to-treatment time was 127.6 min (95% confidence interval 117.1-138.0) using REACH compared with 145.9 min (95% confidence interval 126.9-164.9) in our Emergency Department and 147.8 min in other published systems. REACH, a web-based telestroke system, facilitates the safe administration of thrombolytic therapy to patients within rural communities suffering an acute ischemic stroke.

AB - Patients in rural communities lack access to acute stroke therapies. Rapid administration of thrombolytic therapy increases the likelihood of a favorable outcome in ischemic stroke. We aimed to detail the safety, feasibility, and treatment times of thrombolytic therapy with a web-based telestroke system. At the Medical College of Georgia, we have developed a telestroke system (Remote Evaluation of Acute IsCHemic Stroke; REACH) in which emergency physicians in surrounding counties may consult stroke specialists at our institution. The web-based system allows the stroke consultant to obtain history, examine the patient with live video, and review computed tomography. A recommendation is made regarding the administration of tissue plasminogen activator (tPA) before patient transport to the tertiary medical center. A systematic review of the literature was conducted regarding the use of tPA in academic and community hospitals. Symptomatic hemorrhagic transformation and stroke onset-to-treatment times were compared between the REACH network and other stroke care delivery systems. Between February 2003 and March 2006, 50 patients were treated with intravenous tPA using the REACH telestroke system. There was one (2%) symptomatic hemorrhage. The mean onset-to-treatment time was 127.6 min (95% confidence interval 117.1-138.0) using REACH compared with 145.9 min (95% confidence interval 126.9-164.9) in our Emergency Department and 147.8 min in other published systems. REACH, a web-based telestroke system, facilitates the safe administration of thrombolytic therapy to patients within rural communities suffering an acute ischemic stroke.

KW - cerebrovascular accident

KW - rural hospitals

KW - telemedicine

KW - thrombolytic therapy

UR - http://www.scopus.com/inward/record.url?scp=58249107345&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58249107345&partnerID=8YFLogxK

U2 - 10.1016/j.jemermed.2007.06.041

DO - 10.1016/j.jemermed.2007.06.041

M3 - Article

C2 - 18242925

AN - SCOPUS:58249107345

VL - 36

SP - 12

EP - 18

JO - Journal of Emergency Medicine

JF - Journal of Emergency Medicine

SN - 0736-4679

IS - 1

ER -