BACKGROUND: Telemedicine is increasingly being used in acute stroke care. Some of the first studies and network projects are already applying remote audiovisual communication for patient evaluation. Formerly the telephone was the method of choice to contact experts for case discussion. We compared remote video-examination and telephone consultation in acute stroke care. METHODS: Two district hospitals were linked to stroke centers in Northern Bavaria. Patients with symptoms suggestive of an acute stroke were included. Remote video examination (RVE) was provided by live audiovisual communication and access to brain images; telephone consultation (TC) was done via standard telephone using a structured interview. There was a weekly rotation of the two methods. Demographic data and other data concerning process and quality of care as well as outcome 10 days after stroke were recorded and compared between the two groups. RESULTS: Within the study period 151 consultations were made in acute stroke patients (mean age 66.8 years). 77 patients were seen by RVE and 74 by TC. Total examination times were 49.8 min for RVE and 27.2 min for TC (p < 0.01). Patients were more frequently transferred to the stroke center after TC consultation (9.1 % vs. 14.9 %, p < 0.05) and had a higher mortality 10 days after stroke (6.8 % vs. 1.3 %, p < 0.05). Diagnosis made by TC had to be corrected more frequently (17.6 % vs. 7.1 %; p < 0.05). CONCLUSIONS: Creating a network improves stroke care by establishing cooperation between hospitals. Telephone consultation could be a simple method of telemedicine to support cooperation as it is easy and widely available. However, outcome parameters like mortality indicate that remote video examination is superior to TC. Therefore, full-scale audiovisual communication is recommended for remote consultation in acute stroke care.
BACKGROUND: Telemedicine is increasingly being used in acute stroke care. Some of the first studies and network projects are already applying remote audiovisual communication for patient evaluation. Formerly the telephone was the method of choice to contact experts for case discussion. We compared remote video-examination and telephone consultation in acute stroke care. METHODS: Two district hospitals were linked to stroke centers in Northern Bavaria. Patients with symptoms suggestive of an acute stroke were included. Remote video examination (RVE) was provided by live audiovisual communication and access to brain images; telephone consultation (TC) was done via standard telephone using a structured interview. There was a weekly rotation of the two methods. Demographic data and other data concerning process and quality of care as well as outcome 10 days after stroke were recorded and compared between the two groups. RESULTS: Within the study period 151 consultations were made in acute strokepatients (mean age 66.8 years). 77 patients were seen by RVE and 74 by TC. Total examination times were 49.8 min for RVE and 27.2 min for TC (p < 0.01). Patients were more frequently transferred to the stroke center after TC consultation (9.1 % vs. 14.9 %, p < 0.05) and had a higher mortality 10 days after stroke (6.8 % vs. 1.3 %, p < 0.05). Diagnosis made by TC had to be corrected more frequently (17.6 % vs. 7.1 %; p < 0.05). CONCLUSIONS: Creating a network improves stroke care by establishing cooperation between hospitals. Telephone consultation could be a simple method of telemedicine to support cooperation as it is easy and widely available. However, outcome parameters like mortality indicate that remote video examination is superior to TC. Therefore, full-scale audiovisual communication is recommended for remote consultation in acute stroke care.
Authors: Heinrich J Audebert; Johannes Schenkel; Peter U Heuschmann; Ulrich Bogdahn; Roman L Haberl Journal: Lancet Neurol Date: 2006-09 Impact factor: 44.182
Authors: K Berger; B Weltermann; P Kolominsky-Rabas; S Meves; P Heuschmann; J Böhner; B Neundörfer; H W Hense; T Büttner Journal: Fortschr Neurol Psychiatr Date: 1999-02 Impact factor: 0.752
Authors: B C Meyer; P D Lyden; L Al-Khoury; Y Cheng; R Raman; R Fellman; J Beer; R Rao; J A Zivin Journal: Neurology Date: 2005-03-22 Impact factor: 9.910
Authors: Thomas Pfefferkorn; Martin Liebetrau; Angela Müllner; Andreas Bender; Gerhard F Hamann Journal: J Neurol Date: 2005-07-18 Impact factor: 4.849
Authors: Heinrich J Audebert; Christian Kukla; Stephan Clarmann von Claranau; Johannes Kühn; Bijan Vatankhah; Johannes Schenkel; Guntram W Ickenstein; Roman L Haberl; Markus Horn Journal: Stroke Date: 2004-12-29 Impact factor: 7.914
Authors: Sam Wang; Sung Bae Lee; Carol Pardue; Davinder Ramsingh; Jennifer Waller; Hartmut Gross; Fenwick T Nichols; David C Hess; Robert J Adams Journal: Stroke Date: 2003-09-18 Impact factor: 7.914
Authors: Muhammad A Pervez; Gisele Silva; Shihab Masrur; Rebecca A Betensky; Karen L Furie; Renzo Hidalgo; Fabricio Lima; Eric S Rosenthal; Natalia Rost; Anand Viswanathan; Lee H Schwamm Journal: Stroke Date: 2009-11-12 Impact factor: 7.914
Authors: René Handschu; Angela Wacker; Mateusz Scibor; Camelia Sancu; Stefan Schwab; Frank Erbguth; Patrick Oschmann; David Stark; Lars Marquardt Journal: J Neurol Date: 2015-03-21 Impact factor: 4.849
Authors: Rashid L Bashshur; Gary W Shannon; Brian R Smith; Dale C Alverson; Nina Antoniotti; William G Barsan; Noura Bashshur; Edward M Brown; Molly J Coye; Charles R Doarn; Stewart Ferguson; Jim Grigsby; Elizabeth A Krupinski; Joseph C Kvedar; Jonathan Linkous; Ronald C Merrell; Thomas Nesbitt; Ronald Poropatich; Karen S Rheuban; Jay H Sanders; Andrew R Watson; Ronald S Weinstein; Peter Yellowlees Journal: Telemed J E Health Date: 2014-06-26 Impact factor: 3.536
Authors: René Handschu; Mateusz Scibor; Martin Nückel; Dirk Asshoff; Barbara Willaczek; Frank Erbguth; Stefan Schwab; Frank Daumann Journal: J Neurol Date: 2014-08-01 Impact factor: 4.849
Authors: Mai N Nguyen-Huynh; Jeffrey G Klingman; Andrew L Avins; Vivek A Rao; Abigail Eaton; Sunil Bhopale; Anne C Kim; John W Morehouse; Alexander C Flint Journal: Stroke Date: 2017-12-15 Impact factor: 7.914