A mobile stroke treatment unit (MSTU) equipped with telemedicine, including a neuroradiologist remotely assessing images obtained by mobile CT, may be an effective way to provide accurate care, according to a recent study published in JAMA Neurology that put Cleveland Clinic's unit to the test.
In 2014, 100 patients in Cleveland, Ohio, suffering from an acute onset of stroke-like symptoms were evaluated by a MSTU using telemedicine with a remote physician presence. Ken Uchino, MD, of the Cleveland Clinic’s Cerebrovascular Center, and colleagues examined whether this was a reliable method of care by comparing the results with a control group of patients brought in to the ED via ambulance over the same time period.
Overall, Uchino et al. found that 99 of 100 patients were evaluated by the MSTU successfully. The one unsuccessful case was a connection issue caused by crew error, and the patient was immeditately transported to the nearest ED.
“It is feasible to perform prehospital stroke evaluation and treatment using a telemedicine-enabled MSTU,” the authors wrote. “The system would allow a physician to cover multiple MSTUs and broaden the geographic coverage, rendering the concept more efficient and cost-effective.”
The data revealed that the median time from the door to CT completion was 13 minutes for the MSTU group compared to 18 minutes for the control group. In addition, the median time from the door to intravenous thrombolysis was 32 minutes for the MSTU group and 58 minutes for the control group.
The median time from the door to the CT being read, meanwhile, was the approximately the same for both groups.
The authors added that there were minor technical delays along the way, but none of them had any sort of significant impact.
“None of our delays lasted longer than 1 minute, and there was no effect on patient care,” the authors wrote. “Even in cases of technical delay or difficulty, factors responsible were identified and corrected immediately if possible.”
Martin Ebinger, MD, and Heinrich J. Audebert, MD, of Germany's Charité–Universitätsmedizin Berlin, wrote an editorial for JAMA Neurology to accompany the MSTU study. They suggested that replacing personal interaction with a physician with telemedicine has limitations, but quicker care for patients suffering from an acute onset of stroke-like symptoms may be worth it.
However, they added, more research is still required.
“This assessment seems very logical, but first of all the unequivocal proof of better outcomes after treatment in specialized stroke ambulances is required,” Ebinger and Audebert wrote. “Rigorous costeffectiveness analysis relying on actual data rather than on models or simulations will then help decision makers form an opinion. Detailed analysis of process times from symptom onset to emergency medical services activation, evaluation, and treatments will also be helpful, and further development of teletechnologies will enhance the chances for failure-free operations.”