Abstract 168: Feasibility and Safety of Thrombolysis by Telestroke Through Off-site Mobile Teleconsultation With iPad

Abstract

Introduction: For successful telestroke through the “hub-and-spoke model”, availability of neurologists 24-hour daily in hub hospitals is pivotal for immediate treatment advice. Unfortunately, this luxury is not available in Hong Kong due to shortage of neurologists. To facilitate 24-hour thrombolysis service in Hong Kong, we provide telestroke support with a different model. During non-working hours, when no on-site neurologist is available, patients are evaluated by off-site neurologists through mobile teleconsultation with iPads. On contrary to hub-and-spoke model, where teleconsultations are conducted within the hospital under stable network with direct access to electronic patient records, we perform teleconsultations with iPads outside the hospital where mobile network is location-dependent and access to electronic record is indirectly through a firewalled hospital network. Hypothesis & Objectives: The objective of this study is to evaluate the feasibility and safety of this telestroke model. Methods: We recruited 118 consecutive patients evaluated by off-site mobile telestroke for thrombolysis triage in Prince of Wales Hospital during the period from May 2012 to November 2014. Results: Technical problems were encountered in 27 patients (22.8%), including failure to access CT brain images in 13 cases, which required use of backup teleradiology system. Nevertheless, since the implementation of telestroke, the number of patients who received thrombolysis has increased by > 3-fold. Seventy-eight patients received thrombolysis through telestroke, and had outcome comparable to 84 patients thrombolysed by on-site neurologists. Favorable outcome at 3 months (mRS 0-1) were 46.2% in telestroke group vs 45.2% in on-site group, p = 0.907. Symptomatic intracerebral hemorrhage and mortality were similar between the two groups. Conclusion: Technical problems are common with off-site teleconsultations in the initial implementation of telestroke, that backup teleradiology system is essential. In Hong Kong where mobile network broadly covers most areas in the city, telestroke through off-site mobile teleconsultation with iPad is feasible, safe and significantly facilitates the implementation of 24-hour thrombolysis service.