Original ArticleImpact of Telemedicine Implementation in Thrombolytic Use for Acute Ischemic Stroke: The University of Pittsburgh Medical Center Telestroke Network Experience
Section snippets
Methods
This retrospective study reviewed all consecutive admissions of patients with a primary diagnosis of AIS between March 2005 and December 2008 in the 12 community hospitals that are part of the University of Pittsburgh Medical Center (UPMC) telestroke network. This study was approved by the Central Ethics Committee of UPMC, and informed consent was not required. The medical records review was based on International Classification of Diseases coding, and all admissions coded as occlusion and
Results
A total of 3409 admissions were identified, and 2588 fulfilled the criteria for possible acute stroke. Elective carotid endarterectomy was the most frequent reason for exclusion from final analysis 805 patients. Six patients diagnosed with AIS were excluded from the final analysis because of a lack of data for review.
A total of 139 patients (5.4%) received thrombolytic treatment during the study period. Among the 2588 patients, 919 (35.5%) were admitted during the pretelemedicine phase and 1669
Discussion
This study assessed the impact on frequency of IV tPA use in a community hospital network before and after telestroke support implementation. The rate of IV thrombolytic use increased after telemedicine became available in these hospitals, a finding consistent with previous reports that showed higher rates of IV tPA use in facilities that have accessibility to remote support from vascular neurologists.8, 9, 10, 11, 12 Protocol violations were unfrequent both before and after telemedicine
Acknowledgments
We thank Dr. Cindy Huynh for her assistance with manuscript review.
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Acute Treatment of Ischemic Stroke
2022, Neurologic ClinicsCitation Excerpt :Use of telemedicine to direct thrombolysis treatment has also been shown to have similar complication rates as those reported in the National Institute of Neurologic Disorders and Stroke Trial,1,42 helping to assert the safety of using telemedicine in this capacity. Telemedicine stroke care networks are also a means to increase the use of thrombolysis in rural and underserved areas.43 Improved treatment rates have been attributed to increased access to neurologic expertise.
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2020, Bulletin de l'Academie Nationale de MedecineAcute telestroke in France: A systematic review
2020, Revue NeurologiqueCitation Excerpt :The outcomes of regional acute telestroke activities described in France were similar to results published in the meta-analysis including countries other than France concerning median time to onset of treatment, secondary haemorrhage rate and mortality rates [4,45–48]. The increased thrombolysis rate obtained in the NPDC region (76%) was similar to the range of increase (50% to 150%) reported for other regions such as Victoria, Australia (increase from 17% to 26%) [49], and Pittsburgh, USA (increase from 2.8% to 6.8%) [50]. The increased thrombolysis rate in the FC region (500%) has not, to date, been observed elsewhere, possibly related to the study length (more than 10 years) and the low initial rate before telestroke (less than 1%).
Acute Stroke Trial Enrollment through a Telemedicine Network: A 12-Year Experience
2019, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :The initial development of telestroke networks was prompted by a pressing need to increase IV tPA administration at facilities that lacked the necessary expertise. Within our network, we found that the use of IV tPA at spoke sites increased from 2.8% prior to the use of telemedicine in 2005 to 6.8% after starting telemedicine in 2008.10 Similarly, we now find an increase in the availability of clinical trial participation to these remote sites.
Supported in part by CLIQS0000235. Dr. Jovin is a consultant for Concentric Medical, Inc., Covidien, eV3, NIT, and Stryker. Dr. Wechsler is a member of the Dias 3/4 Data and Safety Monitoring Board.