DOI: 10.1097/01.NT.0000480654.49190.e1
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Issn Print: 1533-7006
Publication Date: 2016/01/21
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Excerpt
A mobile stroke treatment unit that utilizes telemedicine might be a good alternative to having a neurologist on board, according to a report published in the December 7 online edition of JAMA Neurology.
Results from the first 100 patients seen by the Cleveland Clinic's stroke ambulance — which is equipped with a CT scanner, portable laboratory, and telemedicine capabilities to connect with a vascular neurologist — showed that the time from “door” to intravenous thrombolysis was 26 minutes faster for stroke patients evaluated and treated on the mobile unit compared with control patients brought to the emergency department. The study also indicated that the telemedicine technology on board was almost always reliable.
Indeed, as stroke care is increasingly focused on getting clot-busting therapies to patients as quickly as possible, more attention is being paid to optimizing the prehospital phase of care through better triage in the field and organization of stroke services within a given community.
“Studies exploring prehospital delays in stroke care have revealed that only 15 percent to 60 percent of patients having a stroke are able to reach the hospital within three hours of symptom onset,” the study authors noted.
The few other mobile stroke treatment units (MSTUs) in operation in Germany and Houston utilize an on-board neurologist on their response team. While early results from those programs are favorable, one drawback is that it is expensive and not necessarily practical to have a neurologist drive around with the ambulance crew. In some locations, neurologists, especially vascular neurologists, are in short supply.
“An MSTU using telemedicine is feasible, with a low rate of technical failure, and may provide an avenue for reducing the high cost of such systems,” concluded the report from the Cleveland Clinic. The report only evaluated response time and technology reliability; it did not consider whether patient outcomes were better with the MSTU or if the telemedicine approach was cost-effective.
