Stroke Telemedicine: State of Affairs

Abstract

To the Editor: We read with great interest the recent article by Demaerschalk et al1Demaerschalk BM Miley ML Kiernan T-E STARR Coinvestigators et al.Stroke telemedicine.Mayo Clin Proc. 2009; 84: 53-64Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar and the editorial by Meschia2Meschia JF Camera in the emergency department: the evolution of stroke telemedicine [editorial].Mayo Clin Proc. 2009; 84: 3-4Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar about stroke telemedicine. It is a pleasure to see that an increasing number of stroke centers are transferring their expertise to rural areas through telemedicine worldwide. Indeed, the process has been developed much further than described in those articles. For example, studies associated with the Telemedic Project for Integrative Stroke Care (TEMPiS) in Germany demonstrated almost identical long-term mortality and functional outcome after telemedically guided thrombolysis in 170 patients at district hospitals compared with 132 patients with intravenous thrombolysis at 2 stroke centers.3Schwab S Vatankhah B Kukla C TEMPiS Group et al.Long-term outcome after thrombolysis in telemedical stroke care.Neurology. 2007; 69: 898-903Crossref PubMed Scopus (169) Google Scholar In another study associated with TEMPiS,4Audebert HJ Schenkel J Heuschmann PU Bogdahn U Haberl RL Telemedic Pilot Project for Integrative Stroke Care Group Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany.Lancet Neurol. 2006; 5: 742-748Abstract Full Text Full Text PDF PubMed Scopus (243) Google Scholar 1971 patients at telemedicine-supported hospitals with newly established stroke wards were compared with those at matched control hospitals not taking part in the network. Significantly fewer patients at in-network hospitals had a poor outcome after 3 months. In a multivariate regression analysis, specialized stroke treatment in telemedicine network hospitals independently reduced the probability of a poor outcome (odds ratio, 0.62; 95% confidence interval, 0.52-0.74; P<.0001). At 12- and 30-month follow-up, death and dependency were significantly lower in TEMPiS hospitals.5Audebert HJ Schultes K Tietz V Writing Committee for the Telemedical Project for Integrative Stroke Care (TEMPiS) et al.Long-term effects of specialized stroke care with telemedicine support in community hospitals on behalf of the Telemedical Project for Integrative Stroke Care (TEMPiS).Stroke. 2009; 40 (Epub 2008 Nov 20): 902-908Crossref PubMed Scopus (111) Google Scholar During the almost first 4 years of the project, more than 8000 patients were examined via teleconsultation, and for the vast majority, treatment could be continued at the district hospitals without interhospital transfer.6Vatankhah B Schenkel J Fürst A Haberl RL Audebert HJ Telemedically provided stroke expertise beyond normal working hours: the Telemedical Project for Integrative Stroke Care.Cerebrovasc Dis. 2008; 25 (Epub 2008 Feb 27.): 332-337Crossref PubMed Scopus (30) Google Scholar Thus, telemedicine has become a reliable tool in acute stroke care, associated with improved outcome. It is well accepted when used in an integrative approach of organized stroke care. Nevertheless, efficacy data on the use of telemedicine in stroke management are needed from more networks, and the independent effect of teleconsultations on safety and outcome must be demonstrated for more than intravenous thrombolysis. We think that use of telemedicine should increase, eg, to facilitate inclusion of patients with rare causes of stroke into controlled studies. Stroke Telemedicine: State of Affairs–Reply–IMayo Clinic ProceedingsVol. 84Issue 5PreviewWe appreciate the interest that Vatankhah and Audebert have in our recent article and accompanying editorial. We thank them for providing information on their numerous publications generated from the TEMPiS study.1 The network of hospitals in Bavaria that make up TEMPiS has demonstrated that telemedicine can be an effective way of delivering stroke expertise to hospitals that had previously lacked extensive experience with thrombolytic therapy. It is true that the nonrandomized, unblinded, open-intervention TEMPiS study showed that specialized stroke treatment in TEMPiS telemedicine network hospitals independently reduced the probability of a poor outcome. Full-Text PDF