Ritvij Bowry1, Stephanie A Parker1, Jose-Miguel Yamal1,2, Hyunsoo Hwang2, Savitri Appana2, Nicole Rangel-Gutierrez1, Tzu-Ching Wu1, Suja S Rajan3, James C Grotta4. 1. From the Department of Neurology, McGovern Medical School (R.B., S.A.P., J.-M.Y., N.R.-G., T.-C.W.). 2. School of Public Heath, Department of Biostatistics (J.-M.Y., H.H., S.A.). 3. Department of Management Policy and Community Health (S.S.R.), University of Texas Health Science Center, Houston. 4. Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.). james.c.grotta@uth.tmc.edu.
Abstract
BACKGROUND AND PURPOSE: Mobile stroke units (MSUs) can speed treatment with intravenous tPA (tissue-type plasminogen activator). We previously showed substantial agreement between a telemedicine-based vascular neurologist (TM-VN) and an onboard vascular neurologist (OB-VN) for the evaluation of patients with stroke for tPA eligibility on an MSU. However, the time efficiency of the telemedicine-based evaluation remained uncertain. In this study, we examined the speed of decision and treatment from MSU arrival for the TM-VN compared with an OB-VN. METHODS: In 50 consecutive situations, the TM-VN served as the primary decision maker. Times from MSU arrival to tPA decision and tPA bolus were compared with the same metrics for when the OB-VN served as the primary decision maker. RESULTS: Time to tPA decision for the TM-VN was 21 minutes (interquartile range, 16.25-26) versus 18 minutes (interquartile range, 14-22) for the OB-VN (P=0.01). Initiation of tPA bolus was 24 minutes (interquartile range, 19.75-30) for the TM-VN versus 24 minutes (interquartile range, 19-27.75) for the OB-VN (P=0.5). CONCLUSIONS: Assessment by a TM-VN is comparable with an OB-VN in making decisions about tPA administration on an MSU and does not lead to treatment delays. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02190500.
BACKGROUND AND PURPOSE:Mobile stroke units (MSUs) can speed treatment with intravenous tPA (tissue-type plasminogen activator). We previously showed substantial agreement between a telemedicine-based vascular neurologist (TM-VN) and an onboard vascular neurologist (OB-VN) for the evaluation of patients with stroke for tPA eligibility on an MSU. However, the time efficiency of the telemedicine-based evaluation remained uncertain. In this study, we examined the speed of decision and treatment from MSU arrival for the TM-VN compared with an OB-VN. METHODS: In 50 consecutive situations, the TM-VN served as the primary decision maker. Times from MSU arrival to tPA decision and tPA bolus were compared with the same metrics for when the OB-VN served as the primary decision maker. RESULTS: Time to tPA decision for the TM-VN was 21 minutes (interquartile range, 16.25-26) versus 18 minutes (interquartile range, 14-22) for the OB-VN (P=0.01). Initiation of tPA bolus was 24 minutes (interquartile range, 19.75-30) for the TM-VN versus 24 minutes (interquartile range, 19-27.75) for the OB-VN (P=0.5). CONCLUSIONS: Assessment by a TM-VN is comparable with an OB-VN in making decisions about tPA administration on an MSU and does not lead to treatment delays. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02190500.
Authors: Jose-Miguel Yamal; Stephanie A Parker; Asha P Jacob; Suja S Rajan; Ritvij Bowry; Patti Bratina; Mengxi Wang; May Nour; Jason Mackey; Sarah Collins; William Jones; Brandi Schimpf; David Ornelas; Ilana Spokoyny; Jenny Fung Im; Greg Gilbert; Michael Eisshofer; James C Grotta Journal: PLoS One Date: 2021-01-15 Impact factor: 3.240