BACKGROUND: The rate of patients being treated with thrombolytic therapy is low, in part, due to a shortage of vascular neurologists, especially in rural communities. Two-way audio-video communication through telemedicine has been demonstrated to be a reliable method to assess neurologic deficits due to stroke and maybe more efficacious in determining thrombolytic therapy eligibility than telephone-only consultation. OBJECTIVE: To determine the efficacy of telemedicine versus telephone-only consultations for decision making in acute stroke situations. METHODS: The objective was addressed through the development of a structured, critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarian, and clinical content experts in the fields of vascular neurology, emergency medicine, and telemedicine. Participants started with a clinical scenario and a structured question, devised search strategies, located and compiled the best evidence, performed a critical appraisal, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions. RESULTS: : A single randomized, blinded, prospective trial comparing telephone-only consultations to telemedicine consultations for acute stroke was selected and appraised. Correct acute stroke treatment decisions were made more often in the telemedicine group versus the telephone-only group (98% vs. 82%, [number needed to assess = 6]). Stroke telemedicine when compared with telephone-only consultations was more sensitive (100% vs. 58%), more specific (98% vs. 92%), had a more favorable positive likelihood ratio (LR: 41 vs. 7) and negative likelihood ratio (LR: 0 vs. 0.5), and had higher predictive values (positive predictive value 94% vs. 76%, and negative predictive value 100% vs. 84%) for the determination of thrombolysis eligibility. CONCLUSION:Stroke telemedicine when compared with telephone-only consultations is an effective method to determine thrombolysis eligibility for acute stroke patients who do not have immediate access to a stroke neurologist.
RCT Entities:
BACKGROUND: The rate of patients being treated with thrombolytic therapy is low, in part, due to a shortage of vascular neurologists, especially in rural communities. Two-way audio-video communication through telemedicine has been demonstrated to be a reliable method to assess neurologic deficits due to stroke and maybe more efficacious in determining thrombolytic therapy eligibility than telephone-only consultation. OBJECTIVE: To determine the efficacy of telemedicine versus telephone-only consultations for decision making in acute stroke situations. METHODS: The objective was addressed through the development of a structured, critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarian, and clinical content experts in the fields of vascular neurology, emergency medicine, and telemedicine. Participants started with a clinical scenario and a structured question, devised search strategies, located and compiled the best evidence, performed a critical appraisal, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions. RESULTS: : A single randomized, blinded, prospective trial comparing telephone-only consultations to telemedicine consultations for acute stroke was selected and appraised. Correct acute stroke treatment decisions were made more often in the telemedicine group versus the telephone-only group (98% vs. 82%, [number needed to assess = 6]). Stroke telemedicine when compared with telephone-only consultations was more sensitive (100% vs. 58%), more specific (98% vs. 92%), had a more favorable positive likelihood ratio (LR: 41 vs. 7) and negative likelihood ratio (LR: 0 vs. 0.5), and had higher predictive values (positive predictive value 94% vs. 76%, and negative predictive value 100% vs. 84%) for the determination of thrombolysis eligibility. CONCLUSION:Stroke telemedicine when compared with telephone-only consultations is an effective method to determine thrombolysis eligibility for acute strokepatients who do not have immediate access to a stroke neurologist.
Authors: Patricia Martínez-Sánchez; Ambrosio Miralles; Rosa Sanz de Barros; Daniel Prefasi; Borja E Sanz-Cuesta; Blanca Fuentes; Gerardo Ruiz-Ares; Marta Martínez-Martínez; Elena Miñano; Juan José Arévalo-Manso; Elisa Correas-Callero; Andrés Cruz-Herranz; Exuperio Díez-Tejedor Journal: J Neurol Date: 2014-06-24 Impact factor: 4.849
Authors: Morgan R Bobb; Paul G Van Heukelom; Brett A Faine; Azeemuddin Ahmed; Jeffrey T Messerly; Gregory Bell; Karisa K Harland; Christian Simon; Nicholas M Mohr Journal: Acad Emerg Med Date: 2016-06-18 Impact factor: 3.451
Authors: Lawrence R Wechsler; Jack W Tsao; Steven R Levine; Rebecca J Swain-Eng; Robert J Adams; Bart M Demaerschalk; David C Hess; Elena Moro; Lee H Schwamm; Steve Steffensen; Barney J Stern; Steven J Zuckerman; Pratik Bhattacharya; Larry E Davis; Ilana R Yurkiewicz; Aimee L Alphonso Journal: Neurology Date: 2013-02-12 Impact factor: 9.910