Telestroke Evolution

Abstract

See related article, p 2086. Telemedicine in the stroke arena has now progressed from its infancy to its young adulthood with expected growing pains along the way. Its growth over the past 1 to 2 decades has been shockingly fast. Beyond the scope of this editorial is a detailed description of the progress in the field. Instead, this editorial will highlight an apparent change in focus from simply maximizing stroke therapies to optimizing how and when these therapies are delivered. The accompanying article,1 and similar recent publications, focus our attention on the implementation of telestroke into the ambulance setting. This natural growth of telemedicine is highlighting this change in focus from telestroke maximization to optimization. The authors of this article describe a pilot trial assessing the use of telestroke in the prehospital setting. The aim was to assess feasibility and reliability of performing National Institutes of Health Stroke Scale (NIHSS) evaluations in simulated ambulance runs. Real-time audio–video telemedicine devices were placed in 3 ambulances and NIHSS scoring was performed. Forty percent of the scenarios were feasible with weighted κ values of 0.69 for real-time examiners. The article has significance first because it notes early feasibility in ambulances. Second, it highlights a shift away from simply maximizing acute telestroke recombinant tissue-type plasminogen activator (rtPA) and begins a shift toward …