Abstract
Background: Mobile stroke treatment unit (MTSU) with on-site treatment team that includes a stroke physician can provide thrombolysis successfully in pre-hospital setting more quickly than traditional treatment in hospital. We report our initial experience of mobile stroke unit with remote physician presence by telemedicine. Methods: We implemented a MSTU at our institution starting July 18 th , 2014. The unit includes a registered nurse, paramedic, emergency medical personnel, CT technologist. Stroke physician evaluated patient via telemedicine (InTouch RP-Lite) and neuroradioloigst remotely assessed images obtained by Ceretom mobile CT. Data were entered in medical records and a prospective registry. The evaluation and treatment in the first 3 weeks of implementation of MSTU was compared to a control group of patients brought to emergency department (ED) via a traditional ambulance in the preceding 2 months. Times were measured from patient arrival entering the “door” of MSTU or emergency department (ED). Results: Twenty three patients were evaluated by MSTU. All patients were evaluated successfully with CT scan, IV placement, neurologic exam and NIH Stroke scale evaluation over telemedicine, and CT interpretation. Duration of telemedicine evaluation was median 21 minutes (IQR: 17-34 minutes). There was a single 44 second interruption of telemedicine connection that did not affect clinical care. The Median NIHS Stroke Scale was 7 (IQR 2 to 11) and was successfully completed in all 23 patients with assistance of a registered nurse by patient side. The time from door to CT scan completion was similar between MSTU and ED (median 21 minutes and 20 minutes, p=0.70). The time from CT completion to radiologist report to stroke physician was similar between MSTU and ED (median 6 minutes and 4.5 minutes, p=0.18). Conclusion: Mobile stroke unit using telemedicine is feasible and as time efficient as traditional ED evaluation.
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