A study of a mobile videoconferencing system – where paramedics accompanying patients in ambulances confer with doctors through computer tablets – shows it can produce stroke assessments on a par with those done at the hospital bedside. Such a system could help stroke patients receive treatments more promptly and thus reduce the risk of disability and death.
The findings of the clinical trial, by researchers from the University of Virginia (UVA) Health System in Charlottesville, are published in the journal Neurology.
Andrew M. Southerland, assistant professor of neurology and head of the study team, says:
“Acute stroke is a very time-dependent illness. Specifically, in acute ischemic stroke, if you can remove the vascular obstruction and re-vascularize the injured part of the brain in a timely way, you can potentially prevent disability and death.”
In the United States, stroke is a leading cause of serious long-term disability and is responsible for 130,000 deaths a year – that is one out of every 20 deaths.
A stroke is where blood flow to a part of the brain is interrupted because of a blocked or burst blood vessel.
There are three main kinds of stroke: ischemic (blocked blood vessel); hemorrhagic (burst blood vessel); and transient ischemic attacks (TIAs or “mini-strokes”). About 87 percent of all strokes are ischemic strokes.
In the case of ischemic stroke, the sooner it is diagnosed, the sooner the patient can be given a clot-busting drug or undergo a procedure to remove the blockage in the blood vessel and restore blood flow in the brain.
If the blockage is not removed within a few hours of the stroke, the affected brain tissue dies. Because of the time it takes to get to the hospital, many stroke patients have already lost much, if not all, of this window of opportunity before the doctor can even diagnose the condition.
The Improving Treatment with Rapid Evaluation of Acute Stroke via Mobile Telemedicine (iTREAT) study is based on a low-cost computer tablet that is like having the hospital doctor in the ambulance with the patient alongside the paramedic.
- On average, one American
dies from strokeevery 4 minutes
- Nearly one in four strokes are in people who have had one before
- Stroke costs the U.S. an estimated $34 billion each year.
The iTREAT tablet is suction-mounted to the wall of the ambulance. It is connected to a portable modem and antenna, and communicates through encrypted video signals. The system allows the doctor to confer with the patient and the paramedic.
“In our initial feasibility testing,” Prof. Southerland explains, “we partnered with rural ambulance agencies to allow enough time for the stroke assessment and tested our mobile telestroke system in simulated stroke scenarios.”
He and his colleagues found that the system had sufficient quality and connectivity to allow successful consultations in over 90 percent of local test runs.
The team used the National Institutes of Health’s Stroke Scale (NIHSS) as the standard for evaluating the effectiveness of the system. The NIHSS is the standard method neurologists and emergency medicine physicians use to evaluate stroke.
They then got paramedics and hospital doctors to carry out NIHSS assessments using iTREAT during ambulance runs and compared them with scores obtained from bedside assessments done when the patients arrived at the hospital.
The study was carried out at two hospitals: one in central Virginia and the other in the San Francisco Bay Area. There was a total of 27 ambulance runs.
Based on the NIHSS scores, the study found that 96 percent of the iTREAT assessments were as good as assessments performed at the bedside in the hospital.
The researchers conclude that iTREAT enables the emergency team to make better decisions while the patient is in the ambulance and helps cut the time from stroke event to the best treatment. An example of an important decision could be whether the patient should go to the hospital or another specialist center.
The researchers are already running a trial involving real stroke patients. After that, they plan to run a nationwide, multi-center clinical trial.
“The goal of our study is to advance the assessment of acute stroke to the pre-hospital setting – to the ambulance transporting the patients to the hospital.”
Prof. Andrew M. Southerland
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