Telemed J E Health - Telestroke in an urban setting.

Tópicos

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Resumo

CKGROUND: Telestroke is a viable alternative in rural areas where neurologists or stroke expertise is unavailable. Urban applications of telestroke have not been previously described.MATERIALS AND METHODS: All patients evaluated using remote telestroke technology at four urban spoke hospitals between March 2011 and March 2013 were included in this analysis. Telestroke services were provided by vascular fellowship-trained neurologists at one academic stroke center. Patient characteristics, time to initiation of consult, and treatment decisions were prospectively recorded. Stroke triage protocols and thrombolysis rates prior to initiation of telestroke were also obtained.RESULTS: Four hundred ninety-eight patients were evaluated during the study period; mean age was 64.5 years, and 60.4% were female. Median time from initial emergency room call to start of teleconsult was 5 (range, 1-51) minutes. Average length of teleconsult was 30minutes. Technical difficulties occurred in 80 (16.0%) teleconsults, but only 1 was major. Daytime calls (8 a.m.-5 p.m. Monday-Friday) accounted for 38.2% of teleconsults. Two hundred eighty-one patients (56.4%) were determined by teleconsult to have an acute ischemic stroke or transient ischemic attack (TIA). In 72 patients (14.5% overall; 25.6% of all ischemic stroke/TIA patients), intravenous alteplase (tissue plasminogen activator) was recommended. Transfer to the hub hospital occurred in 75 patients (15.1%).CONCLUSIONS: Telestroke is a rapid and effective way to assess patients with suspected acute stroke in an urban setting. Its use may increase access to stroke neurologists and improve thrombolysis rates where competing responsibilities may delay, prevent, and even dissuade on-site evaluation by neurologists.

Resumo Limpo

ckground telestrok viabl altern rural area neurologist stroke expertis unavail urban applic telestrok previous describedmateri method patient evalu use remot telestrok technolog four urban spoke hospit march march includ analysi telestrok servic provid vascular fellowshiptrain neurologist one academ stroke center patient characterist time initi consult treatment decis prospect record stroke triag protocol thrombolysi rate prior initi telestrok also obtainedresult four hundr ninetyeight patient evalu studi period mean age year femal median time initi emerg room call start teleconsult rang minut averag length teleconsult minut technic difficulti occur teleconsult major daytim call pm mondayfriday account teleconsult two hundr eightyon patient determin teleconsult acut ischem stroke transient ischem attack tia patient overal ischem stroketia patient intraven alteplas tissu plasminogen activ recommend transfer hub hospit occur patient conclus telestrok rapid effect way assess patient suspect acut stroke urban set use may increas access stroke neurologist improv thrombolysi rate compet respons may delay prevent even dissuad onsit evalu neurologist

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