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document
Stroke team remote evaluation using a digital observation camera in Arizona : the initial mayo clinic experience trial . BACKGROUND AND PURPOSE Telemedicine techniques can be used to address the rural-metropolitan disparity in acute stroke care . The Stroke Team Remote Evaluation Using a Digital Observation Camera ( STRokE DOC ) trial reported more accurate decision making for telemedicine consultations compared with telephone-only and that the California-based research network facilitated a high rate of thrombolysis use , improved data collection , low risk of complications , low technical complications , and favorable assessment times . The main objective of the STRokE DOC Arizona TIME ( The Initial Mayo Clinic Experience ) trial was to determine the feasibility of establishing , de novo , a single-hub , multirural spoke hospital telestroke research network across a large geographical area in Arizona by replicating the STRokE DOC protocol . METHODS Methods included prospective , single-hub , 2-spoke , randomized , blinded , controlled trial of a 2-way , site-independent , audiovisual telemedicine system designed for remote examination of adult patients with acute stroke versus telephone consultation to assess eligibility for treatment with intravenous thrombolysis . The primary outcome measure was whether the decision to give thrombolysis was correct . Secondary outcomes were rate of thrombolytic use , 90-day functional outcomes , incidence of intracerebral hemorrhages , and technical observations . RESULTS From December 2007 to October 2008 , 54 patients were assessed , 27 of whom were randomized to each arm . Mean National Institutes of Health Stroke Scale score at presentation was 7.3 ( SD 6.2 ) points . No consultations were aborted ; however , technical problems ( 74 % ) were prevalent in the telemedicine arm . Overall , the correct treatment decision was established in 87 % of the consultations . Both modalities , telephone ( 89 % correct ) and telemedicine ( 85 % correct ) , performed well . Intravenous thrombolytic treatment was used in 30 % of the telemedicine and telephone consultations . Good functional outcomes at 90 days were not significantly different . There were no statistically significant differences in mortality ( 4 % in telemedicine and 11 % in telephone ) or rates of intracerebral hemorrhage ( 4 % in telemedicine and 0 % in telephone ) . CONCLUSIONS It is feasible to extend the original STRokE DOC trial protocol to a new state and establish an operational single-hub , multispoke rural hospital telestroke research network in Arizona . The trial was not designed to have sufficient power to detect a difference between the 2 consultative modes : telemedicine and telephone-only . Whether by telemedicine or telephone consultative modalities , there were appropriate treatment decisions , high rates of thrombolysis use , improved data collection , low rates of intracerebral hemorrhage , and equally favorable time requirements . The learning curve was steep for the hub and spoke personnel of the new telestroke network , as reflected by frequent technical problems . Overall , the results support the effectiveness of highly organized and structured stroke telemedicine networks for extending expert stroke care into rural remote communities lacking sufficient neurological expertise .
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Intervention_Educational
telephone-only
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Intervention_Physical
audiovisual telemedicine system designed for remote examination
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Intervention_Physical
telephone consultation to assess eligibility for treatment
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Outcome_Other
decision to give thrombolysis was correct .
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Outcome_Other
rate of thrombolytic use
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Outcome_Physical
90-day functional outcomes
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Outcome_Adverse-effects
incidence of intracerebral hemorrhages
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Outcome_Other
technical observations
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Outcome_Other
technical problems
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Outcome_Other
treatment decision
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Outcome_Physical
functional outcomes
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Outcome_Mortality
mortality
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Outcome_Adverse-effects
rates of intracerebral hemorrhage
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Outcome_Other
treatment decisions
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Outcome_Other
thrombolysis use
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Outcome_Other
data collection
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Outcome_Other
rates of intracerebral hemorrhage
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Outcome_Other
time requirements .
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Participant_Condition
Arizona
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Participant_Age
adult patients
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Participant_Condition
acute stroke
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Participant_Sample-size
54 patients