Telemedicine doesn't speed stroke evaluations

Assessment for stroke took slightly longer using robotic telepresence, but this option still could be effective when the hospital has no vascular neurologist on site, according to research published at Telemedicine and e-Health.

The study compared the assessments of 98 patients evaluated using robotic telepresence with 98 whose care was supervised by a vascular neurologist in house at the Mayo Clinic Hospital in Phoenix. The subjects were identified from a stroke alert database.

The mean duration of time from stroke alert activation to initiation of intravenous thrombolytic treatment or downgrade was 8.6 minutes longer in the robotic group than in the standard group.

Among the subgroup of acute ischemic stroke patients treated with IV thrombolysis, the mean duration of time from activation to treatment was 18 minutes longer in the robotic group than in the standard group. Meanwhile, the safety measures were similar between the two groups.

The authors, however, said the database went back to 2009, when robotic telepresence was first introduced at the hospital, suggesting a learning phase could account for the slower assessments in that group.

Patients in the robotic group also might have had greater impairment from stroke, presented later in the course of their stroke, and required more complex decision making.

The researchers suggested that the supervising neurologist might be more likely to choose to make the assessment with telepresence after hours if a less experienced resident was handling a case.

"Robotic telepresence may be preferable in situations where no stroke specialist is available in-house, especially for middle of the night and weekend staffing of residents, when a 9-minute robot-associated delay is likely better than the delay associated with the supervising physician driving in to the hospital," the authors wrote.

Telestroke units in Germany helped increase the number of rural patients treated and deliver treatment faster, according to a 10-year evaluation published in the journal Stroke.

A review of regulations in the 50 U.S. states that affect the adoption of telemedicine found malpractice and medical liability among barriers to telestroke programs.

To learn more:
- read the research (.pdf)

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