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Remote specialist assessment for intravenous thrombolysis of acute ischaemic stroke by telephone
  1. Matthew Rudd1,
  2. Helen Rodgers2,3,
  3. Richard Curless3,
  4. Mark Sudlow2,3,
  5. Stuart Huntley1,
  6. Badanahatti Madhava3,
  7. Mark Garside1,
  8. Christopher I Price1,2
  1. 1Wansbeck General Hospital, Ashington, Northumberland, UK
  2. 2Newcastle University, Newcastle Upon Tyne, UK
  3. 3North Tyneside General Hospital, North Shields, UK
  1. Correspondence to Dr Christopher I Price, Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK; christopher.price{at}nhct.nhs.uk

Abstract

Objective To describe the process, efficacy and safety of intravenous thrombolysis for acute ischaemic stroke in an emergency department (ED) setting with remote specialist support through structured telephone consultation.

Design Retrospective case series.

Setting Three EDs within a single stroke service in northern England.

Participants Patients with acute stroke given intravenous thrombolytic therapy between 6 September 2007 and 1 October 2010.

Outcome measures Combined death and dependency at 90 days (0–2 on the modified Rankin Scale for a good outcome vs 3–6 for a poor outcome), door-to-needle time, neurological impairment and presence of treatment related haemorrhage.

Results 192 patients received intravenous thrombolysis. 94/178 (53%) were treated after remote specialist assessment. Data available from 178 patients showed similar proportions with a good outcome after each mode of assessment (56% in person and 48% by telephone). The median door-to-needle time was 8 min faster in the group assessed in person (65 vs 73 min by telephone) but there was no difference in neurological outcome or symptomatic haemorrhage. After review in person, the stroke specialist tended to treat patients with a higher median modified Rankin Scale (1 vs 0 by telephone).

Conclusion In a single stroke service the clinical outcomes of treatment with intravenous thrombolysis were similar whether assessment was performed after specialist review in person or via a telemedicine service consisting of ED staff training, telephone consultation and remote review of brain imaging by a stroke specialist.

  • Stroke
  • thrombolytic therapy
  • telemedicine

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Footnotes

  • This manuscript was prepared with reference to the STROBE Statement (http://www.strobe-statement.org).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All information collected had local data protection approval. There was no data sharing as all authors are affiliated with the host organisation.

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