Jithendhar Kandimalla1, Anantha R Vellipuram1, Gustavo Rodriguez1, Alberto Maud1, Salvador Cruz-Flores1, Rakesh Khatri2. 1. Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79905, USA. 2. Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79905, USA. rakesh.khatri@ttuhsc.edu.
Abstract
PURPOSE OF REVIEW: To summarize evidence for the feasibility and the efficacy of mobile stroke units (MSUs) and telemedicine in the field to reduce time delays in offering acute stroke interventions. RECENT FINDINGS: A mobile stroke unit is a modified ambulance and includes sophisticated equipment, either trained personnel on board, or connection with skilled physicians via telemedicine. Stroke assessment and treatment agreeability between the on board and remote neurologist is high in MSUs. MSUs are the promising option to reduce stroke symptom onset to treatment time; telemedicine platform has a satisfactory audiovisual quality, high inter-rater reliability for remote stroke symptom assessment, diagnosis, and decision to treat. Use of MSU also avoids the need for inter-hospital transfers. MSUs improve prehospital stroke care and reduce delays in access to intravenous thrombolytic and mechanical thrombectomy in selective markets. Advancement in telecommunication and modern technology has the potential to make MSU telemedicine-aided management more cost-effective. Further research is needed before its widespread implementation.
PURPOSE OF REVIEW: To summarize evidence for the feasibility and the efficacy of mobile stroke units (MSUs) and telemedicine in the field to reduce time delays in offering acute stroke interventions. RECENT FINDINGS: A mobile stroke unit is a modified ambulance and includes sophisticated equipment, either trained personnel on board, or connection with skilled physicians via telemedicine. Stroke assessment and treatment agreeability between the on board and remote neurologist is high in MSUs. MSUs are the promising option to reduce stroke symptom onset to treatment time; telemedicine platform has a satisfactory audiovisual quality, high inter-rater reliability for remote stroke symptom assessment, diagnosis, and decision to treat. Use of MSU also avoids the need for inter-hospital transfers. MSUs improve prehospital stroke care and reduce delays in access to intravenous thrombolytic and mechanical thrombectomy in selective markets. Advancement in telecommunication and modern technology has the potential to make MSU telemedicine-aided management more cost-effective. Further research is needed before its widespread implementation.
Authors: Shumei Man; Xin Zhao; Ken Uchino; M Shazam Hussain; Eric E Smith; Deepak L Bhatt; Ying Xian; Lee H Schwamm; Shreyansh Shah; Yosef Khan; Gregg C Fonarow Journal: Circ Cardiovasc Qual Outcomes Date: 2018-06
Authors: Seth Seabury; Katalin Bognar; Yaping Xu; Caroline Huber; S Renee Commerford; Darren Tayama Journal: Am J Emerg Med Date: 2017-03-19 Impact factor: 2.469
Authors: Emelia J Benjamin; Paul Muntner; Alvaro Alonso; Marcio S Bittencourt; Clifton W Callaway; April P Carson; Alanna M Chamberlain; Alexander R Chang; Susan Cheng; Sandeep R Das; Francesca N Delling; Luc Djousse; Mitchell S V Elkind; Jane F Ferguson; Myriam Fornage; Lori Chaffin Jordan; Sadiya S Khan; Brett M Kissela; Kristen L Knutson; Tak W Kwan; Daniel T Lackland; Tené T Lewis; Judith H Lichtman; Chris T Longenecker; Matthew Shane Loop; Pamela L Lutsey; Seth S Martin; Kunihiro Matsushita; Andrew E Moran; Michael E Mussolino; Martin O'Flaherty; Ambarish Pandey; Amanda M Perak; Wayne D Rosamond; Gregory A Roth; Uchechukwu K A Sampson; Gary M Satou; Emily B Schroeder; Svati H Shah; Nicole L Spartano; Andrew Stokes; David L Tirschwell; Connie W Tsao; Mintu P Turakhia; Lisa B VanWagner; John T Wilkins; Sally S Wong; Salim S Virani Journal: Circulation Date: 2019-03-05 Impact factor: 29.690
Authors: Opeolu Adeoye; Karin V Nyström; Dileep R Yavagal; Jean Luciano; Raul G Nogueira; Richard D Zorowitz; Alexander A Khalessi; Cheryl Bushnell; William G Barsan; Peter Panagos; Mark J Alberts; A Colby Tiner; Lee H Schwamm; Edward C Jauch Journal: Stroke Date: 2019-05-20 Impact factor: 7.914
Authors: Lawrence R Wechsler; Bart M Demaerschalk; Lee H Schwamm; Opeolu M Adeoye; Heinrich J Audebert; Christopher V Fanale; David C Hess; Jennifer J Majersik; Karin V Nystrom; Mathew J Reeves; Wayne D Rosamond; Jeffrey A Switzer Journal: Stroke Date: 2016-11-03 Impact factor: 7.914
Authors: Silke Walter; Panagiotis Kostpopoulos; Anton Haass; Stefan Helwig; Isabel Keller; Tamara Licina; Thomas Schlechtriemen; Christian Roth; Panagiotis Papanagiotou; Anna Zimmer; Julio Viera; Julio Vierra; Heiko Körner; Kathrin Schmidt; Marie-Sophie Romann; Maria Alexandrou; Umut Yilmaz; Iris Grunwald; Darius Kubulus; Martin Lesmeister; Stephan Ziegeler; Alexander Pattar; Martin Golinski; Yang Liu; Thomas Volk; Thomas Bertsch; Wolfgang Reith; Klaus Fassbender Journal: PLoS One Date: 2010-10-29 Impact factor: 3.240
Authors: Ahmed Itrat; Ather Taqui; Russell Cerejo; Farren Briggs; Sung-Min Cho; Natalie Organek; Andrew P Reimer; Stacey Winners; Peter Rasmussen; Muhammad S Hussain; Ken Uchino Journal: JAMA Neurol Date: 2016-02 Impact factor: 18.302