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Taqui A, Cerejo R, Itrat A, Briggs FBS, Reimer AP, Winners S, Organek N, Buletko AB, Sheikhi L, Cho SM, Buttrick M, Donohue MM, Khawaja Z, Wisco D, Frontera JA, Russman AN, Hustey FM, Kralovic DM, Rasmussen P, Uchino K, Hussain MS. Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis. Neurology 2017; 88:1305-1312. [PMID: 28275084 DOI: 10.1212/wnl.0000000000003786] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 12/19/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the times to evaluation and thrombolytic treatment of patients treated with a telemedicine-enabled mobile stroke treatment unit (MSTU) vs those among patients brought to the emergency department (ED) via a traditional ambulance. METHODS We implemented a MSTU with telemedicine at our institution starting July 18, 2014. A vascular neurologist evaluated each patient via telemedicine and a neuroradiologist and vascular neurologist remotely assessed images obtained by the MSTU CT. Data were entered in a prospective registry. The evaluation and treatment of the first 100 MSTU patients (July 18, 2014-November 1, 2014) was compared to a control group of 53 patients brought to the ED via a traditional ambulance in 2014. Times were expressed as medians with their interquartile ranges. RESULTS Patient and stroke severity characteristics were similar between 100 MSTU and 53 ED control patients (initial NIH Stroke Scale score 6 vs 7, p = 0.679). There was a significant reduction of median alarm-to-CT scan completion times (33 minutes MSTU vs 56 minutes controls, p < 0.0001), median alarm-to-thrombolysis times (55.5 minutes MSTU vs 94 minutes controls, p < 0.0001), median door-to-thrombolysis times (31.5 minutes MSTU vs 58 minutes controls, p = 0.0012), and symptom-onset-to-thrombolysis times (97 minutes MSTU vs 122.5 minutes controls, p = 0.0485). Sixteen patients evaluated on MSTU received thrombolysis, 25% of whom received it within 60 minutes of symptom onset. CONCLUSION Compared with the traditional ambulance model, telemedicine-enabled ambulance-based thrombolysis resulted in significantly decreased time to imaging and treatment.
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Affiliation(s)
- Ather Taqui
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Russell Cerejo
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Ahmed Itrat
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Farren B S Briggs
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Andrew P Reimer
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Stacey Winners
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Natalie Organek
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Andrew B Buletko
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Lila Sheikhi
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Sung-Min Cho
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Maureen Buttrick
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Megan M Donohue
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Zeshaun Khawaja
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Dolora Wisco
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Jennifer A Frontera
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Andrew N Russman
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Fredric M Hustey
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Damon M Kralovic
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Peter Rasmussen
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Ken Uchino
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH
| | - Muhammad S Hussain
- From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
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