BACKGROUND AND PURPOSE: Acute stroke clinical trials are conducted primarily at academic medical centers. As a result, patients living in rural areas are excluded from participation, results may not be generalizable to nonacademic settings, and studies may be slow to recruit subjects. Telemedicine can provide rural patients with emergency neurovascular consultation. We sought to determine whether telemedicine facilitates enrollment into acute stroke trials. METHODS: We have an established rural "hub and spoke" telestroke network. From 2005 to 2009, we participated in 2 time-sensitive acute stroke trials: Factor Seven for Acute Hemorrhagic Stroke and Minocycline to Improve Neurological Outcome. Candidates for the 2 trials could be identified at either the hub or at the spokes, with patients presenting to the latter transferred to the hub for enrollment. We analyzed the times from symptom onset to consultation via telemedicine, arrival at the hub, and to initiation of a study drug to determine the impact of telemedicine on study enrollment. RESULTS:Nineteen of 28 subjects enrolled in the 2 trials were identified initially at an outside facility via a telemedicine link. An additional 9 candidates identified by telemedicine could not be enrolled because of transportation time. Arrival at the hub was 127 minutes later (median, 207 [95% CI, 145 to 255] versus 80 [95% CI, 55 to 142]; P=0.0002), and study drug was started 74 minutes later (median, 298 [95% CI, 218 to 352] versus 225 [95% CI, 147 to 330]; P=0.05) for subjects who were identified via telemedicine and required transport to the hub compared with local subjects who presented directly to the hub. CONCLUSIONS:Telemedicine can enhance enrollment into time-sensitive acute stroke trials. However, transfer of subjects to the hub results in delays in study initiation for some and precludes enrollment for others similar to the weaknesses of "ship and drip" thrombolytic strategies. To save time, efforts are needed to enroll clinical trial subjects and begin the research drug at the remote site under telemedicine guidance.
RCT Entities:
BACKGROUND AND PURPOSE: Acute stroke clinical trials are conducted primarily at academic medical centers. As a result, patients living in rural areas are excluded from participation, results may not be generalizable to nonacademic settings, and studies may be slow to recruit subjects. Telemedicine can provide rural patients with emergency neurovascular consultation. We sought to determine whether telemedicine facilitates enrollment into acute stroke trials. METHODS: We have an established rural "hub and spoke" telestroke network. From 2005 to 2009, we participated in 2 time-sensitive acute stroke trials: Factor Seven for Acute Hemorrhagic Stroke and Minocycline to Improve Neurological Outcome. Candidates for the 2 trials could be identified at either the hub or at the spokes, with patients presenting to the latter transferred to the hub for enrollment. We analyzed the times from symptom onset to consultation via telemedicine, arrival at the hub, and to initiation of a study drug to determine the impact of telemedicine on study enrollment. RESULTS: Nineteen of 28 subjects enrolled in the 2 trials were identified initially at an outside facility via a telemedicine link. An additional 9 candidates identified by telemedicine could not be enrolled because of transportation time. Arrival at the hub was 127 minutes later (median, 207 [95% CI, 145 to 255] versus 80 [95% CI, 55 to 142]; P=0.0002), and study drug was started 74 minutes later (median, 298 [95% CI, 218 to 352] versus 225 [95% CI, 147 to 330]; P=0.05) for subjects who were identified via telemedicine and required transport to the hub compared with local subjects who presented directly to the hub. CONCLUSIONS: Telemedicine can enhance enrollment into time-sensitive acute stroke trials. However, transfer of subjects to the hub results in delays in study initiation for some and precludes enrollment for others similar to the weaknesses of "ship and drip" thrombolytic strategies. To save time, efforts are needed to enroll clinical trial subjects and begin the research drug at the remote site under telemedicine guidance.
Authors: W Kernan; C Viscoli; L Brass; M Amatangelo; A Birch; W Clark; R Conwit; K Furie; M Gorman; B Pesapane; D Kleindorfer; A Lovejoy; J Osborne; S Silliman; R Zweifler; R Horwitz Journal: Clin Trials Date: 2011-08-08 Impact factor: 2.486
Authors: Opeolu Adeoye; Arthur Pancioli; Jane Khoury; Charles J Moomaw; Pamela Schmit; Irene Ewing; Kathleen Alwell; Matthew L Flaherty; Daniel Woo; Simona Ferioli; Pooja Khatri; Joseph P Broderick; Brett M Kissela; Dawn Kleindorfer Journal: J Stroke Cerebrovasc Dis Date: 2011-04-03 Impact factor: 2.136
Authors: J Alfredo Caceres; David M Greer; Joshua N Goldstein; Anand Viswanathan; Jose I Suarez; Logan Brau; Joseph Christopher Zacko; Theodore J Lowenkopf; Chad M Miller; Qaisar A Shah; Ira Chang; Souvik Sen; Steven R Messe; Sherry H Chou; Adnan I Qureshi Journal: J Vasc Interv Neurol Date: 2014-09
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