Telestroke programs may improve rates of tPA use

The use of telestroke consultations improved the rate of treatment with intravenous tissue plasminogen activator (IV-tPA) at community hospitals in patients who have had acute ischemic strokes (AIS), according to a study published in the October issue of Neurosurgery. The percentage of patients who received IV- tPA during the study period was significantly higher than the national average.

Thomas Jefferson University Hospital in Philadelphia provided telemedicine stroke consultations to 1,643 patients in 28 community hospitals between January 2011 and June 2012. Whenever a patient presented to an emergency department (ED) served by the service (a spoke hospital) with signs of AIS, the ED physician calls a “stroke alert” and the telestroke service on-call physician connects wirelessly to a robot in the ED. Consultations last about 10 minutes and recommendations are made to either treat or not treat with IV-tPA. If warranted, patients received IV-tPA at the spoke hospital and either remained there under treatment or were transferred to a primary stroke center.

Throughout the study period, the average amount of time between the stroke alert and the telestroke response was 12 minutes. Of the 1,643 patients, 14 percent met the criteria for IV-tPA treatment, and 97 percent of these patients received the treatment at the spoke hospitals. Nationwide, only 3.4 percent to 5.2 percent of AIS patients received thrombolytic therapy.

Most hospitals in the network increased their IV-tPA use and the number of patients who needed transfer to a specialized stroke center decreased from 44 percent in the first part of 2011 to 19 percent in the first part of 2012.

“In patients experiencing AIS, prompt intravenous thrombolysis is a life-altering treatment,” wrote the authors, led by Nohra Chalouhi, MD, of Thomas Jefferson University. “Only a minority of hospitals, however, are adequately equipped to provide patients with thrombolytic therapy in a timely manner.”

Based on their findings, the authors argued that telestroke services would offer better access to specialized services in areas that need it.