DALLAS, Feb. 5 -- "Telestroke" -- using video conferencing to link stroke specialists with physicians treating stroke patients in small community hospitals -- has an extraordinary potential to save lives and reduce disability, and should be tested now in clinical trials to evaluate its benefits, say researchers in an editorial in this month's Stroke: Journal of the American Heart Association.
"It is time to consider using state-of-the-art video communications technology to maximize the number of patients given effective stroke treatment across the United States," says Steven R. Levine, M.D., of Wayne State University School of Medicine in a commentary article.
In rural areas, many physicians are reluctant to treat stroke patients with clot-dissolving drugs because they are unfamiliar with how to administer them and they worry that it will cause excessive, perhaps fatal bleeding, Levine says.
Telestroke could help allay these concerns says Levine, professor of neurology and director of the Wayne State University/Detroit Medical Center stroke program.
Levine, who heads the university's stroke program, and his co-author Mark Gorman, M.D., also of Wayne State, envision a time when stroke victims at small community hospitals can get the same rapid assessment and treatment now available only at specialized stroke centers at major hospitals.
The concept, dubbed "telestroke," would operate via two-way video conferencing and with desk-top computers to connect a stroke specialist with emergency room personnel in a small hospital. They would work together as a team -- evaluating the patient; administering a stroke-assessment test; reading the patient's imaging scans to determine whether a stroke has occurred; and diagnosing the type of stroke. The stroke specialist also could advise emergency department physicians as they administered medications or performed surgery.
"The doctor who is the stroke expert would interact with the patient as well as the emergency department physician," Levine says. "The doctor can talk to the family of the patient. They can see and talk to the doctor. Basically, the doctor is interacting as if he or she were there, except the doctor can't touch the patient."
Time is of the essence in treating strokes, which strike over 600,000 Americans annually and cost an estimated $41 billion for treatment and rehabilitation of survivors.
The clot-dissolving drug TPA (tissue plasminogen activator) can stop an stroke in its tracks, but it must be administered three hours after the onset of stroke symptoms to be most effective. TPA is used in patients who have strokes caused by blocked blood vessels to the brain. Rapid surgery can save lives of those who have hemorrhagic strokes, caused by a leaking or burst blood vessel in the brain.
By definition, telemedicine ranges from medical consultations and psychotherapy sessions via telephone, to transmitting brain scans to an outside radiologist for reading, to interactive teamwork. The advent of sophisticated medical and communications technologies, however, have created opportunities for extremely sophisticated forms of telemedicine, the two neurologists note.
"In Michigan, where the cost of stroke is a little over $1 billion a year, if we can get TPA in all local community hospitals, we can do a tremendous amount of cost savings, and patients and their families will have a higher quality of life," he says.
Although Levine and others have successfully demonstrated the concept of telestroke, it has never been proven in a formal study, he says. Currently, the University of Iowa is looking at telestroke as part of a much wider trial of telemedicine, which is sponsored by the National Library of Medicine. Wayne State researchers plan to begin a pilot study of telestroke later this year.
"We are going to look at all the things you need to examine to show it's a 'win-win' situation for everyone involved," Levine says. "This has application, not just for stroke, but for all acute brain injuries as well."
Media advisory: Dr. Levine can be reached by phone at 313-745-1540 or by e-mail at slevine@med.wayne.edu. (Please do not publish numbers.)
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