Remote supervision of stroke therapy is safe and effective at smaller hospitals
Research Activities, August 2010, No. 360
Stroke patients have the greatest chance of survival and recovery if they receive intravenous tissue plasminogen activator (IV tPA). This medicine dissolves stroke-causing blood clots. But it must be given within 3 hours of the onset of a stroke in order for it to be most effective. Regional stroke center hospitals are well-equipped with the drug and stroke specialists to provide this type of care immediately. Smaller, outlying hospitals, however, may not have a stroke specialist available onsite to administer the drug. The good news is that IV tPA can be given safely and effectively at outlying hospitals when a neurologist supervises the procedure using telemedicine or telephone guidance. The patient can then be moved to a regional stroke center.
Researchers reviewed a stroke database to identify 296 patients who had received IV tPA within 3 hours of the start of symptoms. Of these, 181 received care at outlying hospitals without a stroke specialist available 24/7. The other 115 received treatment at a regional stroke center. There were no differences between patients treated at outlying hospitals and regional stroke centers in treatment complications, mortality, and discharge and functional outcomes.
Among survivors, patients receiving treatment with IV tPA at outlying hospitals did have shorter hospital stays than patients treated at stroke centers. However, their discharge status was similar and 75 percent of patients were able to walk out of the hospital on their own. With only 4 neurologists per 100,000 persons in the United States, and recent evidence suggesting IV tPA is effective up to 4.5 hours after symptom onset, remote support of IV tPA will play a crucial role in caring for stroke victims, conclude the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS11392).
See "Remote supervision of IV-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe," by Muhammad A. Pervez, M.D., Gisele Silva, M.D., Ph.D., Shibab Masrur, M.D., and others in the January 2010 Stroke 41, pp. e18-e24.