Telemedicine improves stroke evaluations in rural areas
1 April 2010
A growing number of medical centers in the US that have access
to stroke specialists are transmitting their expertise to rural
communities via audio/video telemedicine consultation with significant
clinical results, according to a new clinical study.
The study, Pooled Analysis of the STRokE DOC and STRokE DOC-AZ
Telemedicine Stroke Trials, followed two primary "hub" stroke
centers — Mayo Clinic in Arizona and the University of California,
San Diego — and six rural "spoke" hospitals.
Results show that compared with telephone consultations,
telemedicine evaluation of stroke patients results in more accurate
diagnoses, better emergency decision-making, fewer complications and
encouraging long-term outcomes. STRokE DOC (stroke team remote
evaluation using a digital observation camera) connects stroke
specialists at the hub site to a remote spoke site using an internet
According to Bart Demaerschalk MD, Mayo Clinic neurologist and
principal investigator of the Arizona trial, "This pooled analysis,
with replication of the hub-and- spoke network infrastructure,
supports that telemedicine could be generalized to broader rural
settings and communities — among more states, hospitals, and
Investigators were encouraged by the pooled results that
allowed for a larger patient sample size that was able to
demonstrate good 90-day outcomes.
The 276 patients exhibiting symptoms of stroke at their
respective emergency departments were randomly assigned to telephone
consultations versus two-way telemedicine consultations using a
digital observation camera.
Results of the five-year study showed that the correct emergency
stroke treatment decision-making was made 96% of the time with the
audio/video telemedicine technology, compared with 83% for telephone
Importantly, diagnosis by telemedicine means that use of
clot-busting medications for stroke can be increased to 29%, noting
that one in three acute stroke patients are able to receive
disability-reducing emergency clot-busting medications. Previously,
fewer than 5% of patients in the rural communities had access to
Current data shows that only 55% of Americans have access to
primary stroke centers within 60 minutes. Roughly 135 million people
in the US do not have access to a primary stroke facility located
within an hour of their home. "Patients in less densely populated
areas may not have immediate access to acute stroke expertise and
may not be availed of clot-busting medication necessary for
treatment," says Dr. Demaerschalk.
The process of stroke telemedicine goes like this: A call is
placed from one of the remote spoke rural hospitals to one of the
hub medical centers. The hub vascular neurologist is equipped with a
"telemedicine tool belt," including a smart phone with a
teleradiology application and other technology such as a laptop with
a web cam.
The remote, spoke hospital is equipped with a mobile robot
telemedicine camera system that is positioned near the patient's
bed. From afar, the stroke physician can observe and speak with the
patient, and healthcare providers do a real-time consultation and
review CT scans of the brain. If a diagnosis of stroke is confirmed,
appropriate treatment can be quickly administered, such as a
clot-busting drug when a clot is blocking blood flow to the brain.
"Results of this trial are significant, in that they confirm the
effectiveness of telemedicine as a tool to evaluate acute stroke.
This leads to appropriate decisions on behalf of patients — timely
treatment, low complication rates and good long-term outcomes," says
Results of the study were presented at the 2010 International
Stroke Conference in San Antonio in February.