Hostname: page-component-7c8c6479df-995ml Total loading time: 0 Render date: 2024-03-28T21:52:52.578Z Has data issue: false hasContentIssue false

Telemedicine in acute stroke management: Systematic review

Published online by Cambridge University Press:  15 April 2010

Tim Johansson
Affiliation:
Ludwig Boltzmann Institute for Health Technology Assessment
Claudia Wild
Affiliation:
Ludwig Boltzmann Institute for Health Technology Assessment

Abstract

Objectives: Stroke is the third largest cause of death and a major factor in permanent disability. Disparities in access to healthcare services exist due to geographical barriers and limited resources. Rural locations often lack the resources for adequate acute stroke care. Telestroke is intended to enable the transfer of knowledge of acute stroke management to areas with limited neurological services. The objective of this study is to assess the feasibility, acceptability, and treatment delivery reliability of telemedicine systems in acute stroke management.

Methods: A systematic review was undertaken.

Results: Eighteen studies were included in this systematic review. Telestroke services have been reported to lead to better functional health outcomes, including reduced mortality and dependency, compared with conventional care. Most studies report that systemic tissue plasminogen activator (tPA) treatment increased in hospitals providing telestroke services, although patients were often transferred to a stroke center for continuing monitoring and surveillance. Patients and healthcare providers reported high levels of satisfaction. There was limited evidence regarding the impact on resource utilization and cost-effectiveness.

Conclusions: Telemedicine systems can be safe, feasible, and acceptable in acute stroke management. Telestroke is associated with increased delivery of tPA. The lack of standardized measuring and reporting of resources and health outcomes hinder comparisons between telestroke networks and the determination of best practices. More research is needed to explore the clinical and economic impact of telemedicine technologies in acute stroke management, so as to support policy makers in making informed decisions.

Type
ASSESSMENTS
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Organised inpatient (stroke unit) care for stroke. Stroke Unit Trialists’ Collaboration. Cochrane Database of Syst Rev (Online). 2000;2:CD000197.Google Scholar
2. Audebert, HJ, Kukla, C, Clarmann von Claranau, S, et al. Telemedicine for safe and extended use of thrombolysis in stroke: The Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria. Stroke. 2005;36:287291.Google Scholar
3. Audebert, HJ, Kukla, C, Vatankhah, B, et al. Comparison of tissue plasminogen activator administration management between telestroke network hospitals and academic stroke centers: The telemedical pilot project for integrative stroke care in Bavaria/Germany. Stroke. 2006;37:18221827.Google Scholar
4. Audebert, HJ, Schenkel, J, Heuschmann, PU, et al. Effects of the implementation of a telemedical stroke network: The Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany [see comment]. Lancet Neurol. 2006;5:742748.Google Scholar
5. Audebert, HJ, Schultes, K, Tietz, V, et al. Long-term effects of specialized stroke care with telemedicine support in community hospitals on behalf of the Telemedical Project for Integrative Stroke Care (TEMPiS). Stroke. 2009;40:902908.Google Scholar
6. Caro, JJ, Huybrechts, KF, Duchesne, I. For the Stroke Economic Analysis Group. Management patterns and costs of acute ischemic stroke: An international study. Stroke. 2000;31:582590.Google Scholar
7. Choi, JY, Porche, NA, Albright, KC, et al. Using telemedicine to facilitate thrombolytic therapy for patients with acute stroke. Jt Comm J Qual Patient Saf. 2006;32:199205.Google Scholar
8. Demaerschalk, BM, Miley, ML, Kiernan, TE, et al. Stroke telemedicine. Mayo Clin Proc. 2009;84:5364.Google Scholar
9. Deshpande, A, Khoja, S, McKibbon, A, et al. Telehealth for acute stroke management (Telestroke): Systematic review of analytic studies and environmental scan of relevant initiatives. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH); 2008.Google Scholar
10. Frey, JL, Jahnke, HK, Goslar, PW, et al. tPA by telephone: Extending the benefits of a comprehensive stroke center. Neurology. 2005;64:154156.Google Scholar
11. Handschu, R, Scibor, M, Willaczek, B, et al. Telemedicine in acute stroke: Remote video-examination compared to simple telephone consultation. J Neurol. 2008;255:17921797.Google Scholar
12. Hess, DC, Wang, S, Hamilton, W, et al. REACH: Clinical feasibility of a rural telestroke network. Stroke. 2005;36:20182020.Google Scholar
13. Kuhle, S, Mitchell, L, Andrew, M, et al. Urgent clinical challenges in children with ischemic stroke: Analysis of 1065 patients from the 1-800-NOCLOTS pediatric stroke telephone consultation service [see comment]. Stroke. 2006;37:116122.Google Scholar
14. LaMonte, MP, Bahouth, MN, Hu, P, et al. Telemedicine for acute stroke: Triumphs and pitfalls. Stroke. 2003;34:725728.Google Scholar
15. Lopez, AD, Mathers, CD, Ezzati, M, et al. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet. 2006;367:17471757.Google Scholar
16. Meyer, BC, Raman, R, Hemmen, T, et al. Efficacy of site-independent telemedicine in the STRokE DOC trial: A randomised, blinded, prospective study [see comment]. Lancet Neurol. 2008;7:787795.Google Scholar
17. Rymer, MM, Thurtchley, D, Summers, D. Expanded modes of tissue plasminogen activator delivery in a comprehensive stroke center increases regional acute stroke interventions. Stroke. 2003;34:e58e60.Google Scholar
18. Sandercock, P, Berge, E, Dennis, M, et al. Cost-effectiveness of thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke assessed by a model based on UK NHS costs. Stroke. 2004;35:14901497.Google Scholar
19. Schwamm, LH, Holloway, RG, Amarenco, P, et al. A review of the evidence for the use of telemedicine within stroke systems of care. A Scientific Statement From the American Heart Association/American Stroke Association. Stroke. 2009;40:26162634.Google Scholar
20. Schwamm, LH, Rosenthal, ES, Hirshberg, A, et al. Virtual TeleStroke support for the emergency department evaluation of acute stroke. Acad Emerg Med. 2004;11:11931197.Google Scholar
21. Standing Committee of European Doctors (CPME). CPME guidelines for telemedicine. Brussels, Belgium: CPME; 2002.Google Scholar
22. Vaishnav, AG, Pettigrew, LC, Ryan, S, et al. Telephonic guidance of systemic thrombolysis in acute ischemic stroke: Safety outcome in rural hospitals. Clin Neurol Neurosurg. 2008;110:451454.Google Scholar
23. Waite, K, Silver, F, Jaigobin, C, et al. Telestroke: A multi-site, emergency-based telemedicine service in Ontario. J Telemed Telecare. 2006;12:141145.Google Scholar
24. Wang, DZ, Rose, JA, Honings, DS, et al. Treating acute stroke patients with intravenous tPA. The OSF stroke network experience. Stroke. 2000;31:7781.Google Scholar
25. Wang, S, Gross, H, Lee, SB, et al. Remote evaluation of acute ischemic stroke in rural community hospitals in Georgia. Stroke. 2004;35:17631768.Google Scholar
26. Wardlaw, JM, Zoppo, G, Yamaguchi, T, Berge, E. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev (Online). 2003;3:CD000213.Google Scholar
27. Wiborg, A, Widder, B; Telemedicine in Stroke in Swabia Project. Teleneurology to improve stroke care in rural areas: The Telemedicine in Stroke in Swabia (TESS) Project [see comment]. Stroke. 2003;34:29512956.Google Scholar
28. Wong, HT, Poon, WS, Jacobs, P, et al. The comparative impact of video consultation on emergency neurosurgical referrals. Neurosurgery. 2006;59:607613; discussion 613.Google Scholar
Supplementary material: File

Johansson et al. supplementary material

Supplementary tables

Download Johansson et al. supplementary material(File)
File 17.4 KB