Original Article
Assessment of Long-Term Outcomes for the STRokE DOC Telemedicine Trial

https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.08.004Get rights and content

Telemedicine can provide stroke evaluations in locations with limited available expertise. The reliability of telestroke has been established. Decision making efficacy has been shown in the National Institutes of Health’s STRokE DOC trial. No prospective trial has assessed long-term telestroke outcomes, however. In an institutional review board-approved trial (NCT00936455), we contacted patients originally enrolled in the STRokE DOC trial. A telephone script was used to verify consent. Patients were asked standardized questions regarding disposition, modified Rankin Scale (mRS) score, mortality, and recurrent stroke for 2 retrospective time points (6 and 12 months postevent) and one current time point. Blind was maintained. Primary outcome measures of mortality and percent mRS score of 0-1 [%mRS(0-1)] at 6 months are reported. Wilcoxon’s rank-sum test was used for continuous variables, and Fisher’s exact was used for categorical variables. Of the original 222 participants, 75 patients or surrogates could be contacted. Mean time from enrollment was 3.96 ± 1.0 years (range, 2.33-5.45 years). Mean National Institutes of Health Stroke Scale (NIHSS) score was 8 ± 7 (5 ± 8 for telephone; 12 ± 8 for telemedicine; P = .002). The rate of intravenous recombinant tissue plasminogen activator (rt-PA) use was 31%. Six-month %mRS(0-1) outcome was not different, at 42%. Mortality after imputation to the entire study sample also was not different, at 18%. There was no difference in the rate of recurrent stroke (P = .61). Some 85% of patients were home at 6 months. This study reports a good 6-month outcome for stroke patients evaluated by telemedicine or telephone. This design is limited by the time since original enrollment and resultant inability to contact participants. Although these findings can add to the limited data on telemedicine outcomes, a prospective trial is needed.

Section snippets

Materials and Methods

The original STRokE DOC trial design has been published.18 STRokE DOC was an National Institutes of Health (NIH)-funded prospective, multisite, randomized trial comparing the decision making efficacy of two consultation techniques. Patients underwent either a telemedicine or telephone-only consultation, with cases reviewed at 3 levels of data availability. Primary outcomes showed correct 98% decision making efficacy for telemedicine, compared with 82% for telephone. Mortality at 90 days did not

Results

Table 1 presents baseline characteristics of our sample. Of the original 222 participants, 35 died within the specified trial period. Of the remaining 187, 75 participants (or surrogates) could be contacted (38 by telephone, 37 by telemedicine). The mean time from original enrollment to contact for STRokE DOC-LTO was 3.96 years (range, 2.33-5.45 years). The mean age of the participants was 67 ± 13 years. The sample was 55% male (P = .65), 93% white (P = .49), and 33% reported being Hispanic (P

Discussion

Recent database information supports the safety and feasibility of “drip and ship” rt-PA models by demonstrating similar discharge status whether treated at outside spoke hospitals and then transferred or treated at hub centers directly.26 Other investigators have reported good outcomes when combining stroke wards, education initiatives, and telemedicine.27 Data also show good long-term outcomes at 6 months.21 Those previous nonrandomized reports are integral to the understanding of

Acknowledgment

We acknowledge the assistance of the California Institute of Telecommunications Technology and BF Technologies for their work in the original STRokE DOC trial, as well as our collaborating hospital sites/participating spoke facilities (Pioneers Memorial Hospital, El Centro Regional Medical Center, Palomar Medical Center, and Twin Cities Memorial Hospital).

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    Supported in part by the National Institute of Neurological Disorders and Stroke (Grant P50NS044148).

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