TY - JOUR
T1 - Telemedicine versus telephone for remote emergency stroke consultations
T2 - A critically appraised topic
AU - Capampangan, Dan J.
AU - Wellik, Kay E.
AU - Bobrow, Bentley J.
AU - Aguilar, Maria I.
AU - Ingall, Timothy J.
AU - Kiernan, Terri Ellen
AU - Wingerchuk, Dean M.
AU - Demaerschalk, Bart M.
PY - 2009/5
Y1 - 2009/5
N2 - Background: The rate of patients being treated with thrombolytic therapy is low, in part, due to a shortage of vascular neurologists, especially in rural communities. Two-way audio-video communication through telemedicine has been demonstrated to be a reliable method to assess neurologic deficits due to stroke and maybe more efficacious in determining thrombolytic therapy eligibility than telephone-only consultation. OBJECTIVE:: To determine the efficacy of telemedicine versus telephone-only consultations for decision making in acute stroke situations. Method: The objective was addressed through the development of a structured, critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarian, and clinical content experts in the fields of vascular neurology, emergency medicine, and telemedicine. Participants started with a clinical scenario and a structured question, devised search strategies, located and compiled the best evidence, performed a critical appraisal, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions. Results: A single randomized, blinded, prospective trial comparing telephone-only consultations to telemedicine consultations for acute stroke was selected and appraised. Correct acute stroke treatment decisions were made more often in the telemedicine group versus the telephone-only group (98% vs. 82%, [number needed to assess = 6]). Stroke telemedicine when compared with telephone-only consultations was more sensitive (100% vs. 58%), more specific (98% vs. 92%), had a more favorable positive likelihood ratio (LR: 41 vs. 7) and negative likelihood ratio (LR: 0 vs. 0.5), and had higher predictive values (positive predictive value 94% vs. 76%, and negative predictive value 100% vs. 84%) for the determination of thrombolysis eligibility. Conclusion: Stroke telemedicine when compared with telephone-only consultations is an effective method to determine thrombolysis eligibility for acute stroke patients who do not have immediate access to a stroke neurologist.
AB - Background: The rate of patients being treated with thrombolytic therapy is low, in part, due to a shortage of vascular neurologists, especially in rural communities. Two-way audio-video communication through telemedicine has been demonstrated to be a reliable method to assess neurologic deficits due to stroke and maybe more efficacious in determining thrombolytic therapy eligibility than telephone-only consultation. OBJECTIVE:: To determine the efficacy of telemedicine versus telephone-only consultations for decision making in acute stroke situations. Method: The objective was addressed through the development of a structured, critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarian, and clinical content experts in the fields of vascular neurology, emergency medicine, and telemedicine. Participants started with a clinical scenario and a structured question, devised search strategies, located and compiled the best evidence, performed a critical appraisal, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions. Results: A single randomized, blinded, prospective trial comparing telephone-only consultations to telemedicine consultations for acute stroke was selected and appraised. Correct acute stroke treatment decisions were made more often in the telemedicine group versus the telephone-only group (98% vs. 82%, [number needed to assess = 6]). Stroke telemedicine when compared with telephone-only consultations was more sensitive (100% vs. 58%), more specific (98% vs. 92%), had a more favorable positive likelihood ratio (LR: 41 vs. 7) and negative likelihood ratio (LR: 0 vs. 0.5), and had higher predictive values (positive predictive value 94% vs. 76%, and negative predictive value 100% vs. 84%) for the determination of thrombolysis eligibility. Conclusion: Stroke telemedicine when compared with telephone-only consultations is an effective method to determine thrombolysis eligibility for acute stroke patients who do not have immediate access to a stroke neurologist.
KW - Critically appraised topic
KW - Diagnosis
KW - Evidence-based medicine
KW - Remote consultation
KW - Stroke
KW - Telemedicine
KW - Telephone
KW - Thrombolytic therapy
KW - Videoconferencing
UR - http://www.scopus.com/inward/record.url?scp=67649827619&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=67649827619&partnerID=8YFLogxK
U2 - 10.1097/NRL.0b013e3181a4b79c
DO - 10.1097/NRL.0b013e3181a4b79c
M3 - Article
C2 - 19430275
AN - SCOPUS:67649827619
SN - 1074-7931
VL - 15
SP - 163
EP - 166
JO - Neurologist
JF - Neurologist
IS - 3
ER -