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Alhajala H, Hendricks-Jones M, Shawver J, Amllay A, Chen JT, Hajjar M, Robbins S, Dwyer T, Sedlak E, Crayne C, Miller B, Kung V, Burgess R, Jumaa M, Zaidi SF. Expansion of Telestroke Coverage in Community Hospitals: Unifying Stroke Care and Reducing Transfer Rate. Ann Neurol 2024; 95:576-582. [PMID: 38038962 DOI: 10.1002/ana.26839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Telestroke (TS) service has been shown to improve stroke diagnosis timing and accuracy, facilitate treatment decisions, and decrease interfacility transfers. Expanding TS service to inpatient units at the community hospital provides an opportunity to follow up on stroke patients and optimize medical management. This study examines the outcome of expanding TS coverage from acute emergency room triage to incorporate inpatient consultation. METHODS We studied the effect of expanding TS to inpatient consultation service at 19 regional hospitals affiliated with Promedica Stroke Network. We analyzed data pre- and post-TS expansion. We reviewed changes in TS utilization, admission rate, thrombolytic therapy, patient transfer rate, and diagnosis accuracy. RESULTS Between January 2018 and June 2022, a total of 9,756 patients were evaluated in our stroke network (4,705 in pre- and 5,051 in the post-TS expansion). In the post-TS expansion period, stroke patients' admission at the spoke hospital increased from 18/month to 40/month, and for TIA from 11/month to 16/month. TS cart use increased from 12% to 35.2%. Patient transfers to hub hospital decreased by 31%. TS service expansion did not affect intravenous thrombolytic therapy rate or door-to-needle time. There was no difference in length of stay or readmission rate, and the patients at the spoke hospitals had a higher rate of home discharge 57.38% compared with 52.58% at hub hospital. INTERPRETATION Telestroke service expansion to inpatient units helped decrease transfers and retain patients in their communities, increased stroke and TIA diagnosis accuracy, and did not compromise patients' hospitalization or outcome. ANN NEUROL 2024;95:576-582.
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Affiliation(s)
- Hisham Alhajala
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | | | - Julie Shawver
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | | | - John Tuhao Chen
- Department of Statistics, Bowling Green State University, Bowling Green, OH, USA
| | - Monica Hajjar
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Sarah Robbins
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Trisha Dwyer
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Emily Sedlak
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | | | - Brian Miller
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Vieh Kung
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | - Richard Burgess
- Department of Neurology, University of Toledo, Toledo, OH, USA
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo, Toledo, OH, USA
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Syed F Zaidi
- Department of Neurology, University of Toledo, Toledo, OH, USA
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
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Kim J, Olaiya MT, De Silva DA, Norrving B, Bosch J, De Sousa DA, Christensen HK, Ranta A, Donnan GA, Feigin V, Martins S, Schwamm LH, Werring DJ, Howard G, Owolabi M, Pandian J, Mikulik R, Thayabaranathan T, Cadilhac DA. Global stroke statistics 2023: Availability of reperfusion services around the world. Int J Stroke 2024; 19:253-270. [PMID: 37853529 PMCID: PMC10903148 DOI: 10.1177/17474930231210448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Disparities in the availability of reperfusion services for acute ischemic stroke are considerable globally and require urgent attention. Contemporary data on the availability of reperfusion services in different countries are used to provide the necessary evidence to prioritize where access to acute stroke treatment is needed. AIMS To provide a snapshot of published literature on the provision of reperfusion services globally, including when facilitated by telemedicine or mobile stroke unit services. METHODS We searched PubMed to identify original articles, published up to January 2023 for the most recent, representative, and relevant patient-level data for each country. Keywords included thrombolysis, endovascular thrombectomy and telemedicine. We also screened reference lists of review articles, citation history of articles, and the gray literature. The information is provided as a narrative summary. RESULTS Of 11,222 potentially eligible articles retrieved, 148 were included for review following de-duplications and full-text review. Data were also obtained from national stroke clinical registry reports, Registry of Stroke Care Quality (RES-Q) and PRE-hospital Stroke Treatment Organization (PRESTO) repositories, and other national sources. Overall, we found evidence of the provision of intravenous thrombolysis services in 70 countries (63% high-income countries (HICs)) and endovascular thrombectomy services in 33 countries (68% HICs), corresponding to far less than half of the countries in the world. Recent data (from 2019 or later) were lacking for 35 of 67 countries with known year of data (52%). We found published data on 74 different stroke telemedicine programs (93% in HICs) and 14 active mobile stroke unit pre-hospital ambulance services (80% in HICs) around the world. CONCLUSION Despite remarkable advancements in reperfusion therapies for stroke, it is evident from available patient-level data that their availability remains unevenly distributed globally. Contemporary published data on availability of reperfusion services remain scarce, even in HICs, thereby making it difficult to reliably ascertain current gaps in the provision of this vital acute stroke treatment around the world.
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Affiliation(s)
- Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Deidre A De Silva
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jackie Bosch
- School of Rehabilitation Science, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Diana A De Sousa
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Hanne K Christensen
- Department of Neurology, University of Copenhagen and Bispebjerg Hospital, Copenhagen, Denmark
| | - Anna Ranta
- Department of Medicine, University of Otago, Wellington, Wellington, New Zealand
| | - Geoffrey A Donnan
- Melbourne Brain Centre, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Sheila Martins
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - George Howard
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Robert Mikulik
- Health Management Institute, Brno, Czech Republic
- Neurology Department, Bata Hospital, Zlin, Czech Republic
| | - Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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Fernandes JG. Artificial Intelligence in Telemedicine. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Artificial Intelligence in Telemedicine. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_93-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ali F, Hamid U, Zaidat O, Bhatti D, Kalia JS. Role of Artificial Intelligence in TeleStroke: An Overview. Front Neurol 2020; 11:559322. [PMID: 33117259 PMCID: PMC7576935 DOI: 10.3389/fneur.2020.559322] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023] Open
Abstract
Teleneurology has provided access to neurological expertise and state-of-the-art stroke care where previously they have been inaccessible. The use of Artificial Intelligence with machine learning to assist telestroke care can be revolutionary. This includes more rapid and more reliable diagnosis through imaging analysis as well as prediction of hospital course and 3-month prognosis. Intelligent Electronic Medical Records can search free text and provide decision assistance by analyzing patient charts. Speech recognition has advanced enough to be reliable and highly convenient. Smart contextually aware communication and alert programs can enhance efficiency of patient flow and improve outcomes. Automated data collection and analysis can make quality improvement and research projects quicker and much less burdensome. Despite current challenges, these synergistic technologies hold immense promise in enhancing the clinician experience, helping to reduce physician burnout while improving patient health outcomes at a lower cost. This brief overview discusses the multifaceted potential of AI use in telestroke.
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Affiliation(s)
- Faryal Ali
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Umair Hamid
- Department of Neurology, University of Illinois, College of Medicine, Peoria, IL, United States
| | - Osama Zaidat
- Departments of Endovascular Neurosurgery and Stroke, St. Vincent Mercy Medical Center, Toledo, OH, United States
| | - Danish Bhatti
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Junaid Siddiq Kalia
- AINeuroCare, Dallas, TX, United States.,Clinical Strategy, VeeMed Inc., Roseville, CA, United States
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Sanchez S, Campos Y, Cadena A, Habib S, Deprince M, Chalouhi N, Vibbert M, Urtecho J, Athar MK, Tzeng D, Sheehan L, Bell R, Tjoumakaris S, Jabbour P, Rosenwasser R, Rincon F. Intravenous thrombolysis in the elderly is facilitated by a tele-stroke network: A cross-sectional study. Clin Neurol Neurosurg 2020; 197:106177. [PMID: 32861925 DOI: 10.1016/j.clineuro.2020.106177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Data suggest that elderly patients have less favorable outcomes after ischemic stroke. OBJECTIVE To study the outcomes after intravenous tissue plasminogen activator (tPA) administration in elderly patients with acute ischemic stroke. METHODS Cross-sectional study using prospective collected patient data maintained via our "tele-stroke" network, which provides acute care in 29 community hospitals within our region from 2013-2015. Exposure of interest was age divided into >80 years (octogenarian) or younger. Outcomes of interest were rate of intravenous tPA administration, hemorrhagic transformation (ICH), in-hospital neurological deterioration, and poor outcome defined as a composite of hospital discharge to long-term care facility or death. RESULTS Mean age 67 ± 16 years, 57 % (743/1317) were women, and median (Md) NIHSS was 4 (Interquartile Range [IQR] 8). The rate of tPA was 20 % (267/1317). Compared to reported rates of tPA administration in the nation, our tPA rate exceeded the one from the literature (20 % v 3%, z = 2.83, SE = 0.04, p = .005). There were no differences in ICH or neurological deterioration. The octogenarian group had a higher proportion of poor-outcome (61 % vs. 23 %, p < 0.001) than the younger group but similar in-hospital case-fatality (25 % v 14 %, p = 0.09). Predictors of poor-outcome were age >80 (OR 4.9; CI, 2.0-12, p < .001) and α-NIHSS>9. (OR 8.7; CI, 3.5-20, p < .001). CONCLUSION Our data suggest that in our "tele-stroke" network, rates of tPA administration are higher than those reported in the literature and that this rate was not different in octogenarians compared to younger patients. Octogenarians were not at risk for ICH or neurological deterioration after tPA administration. However, octogenarians had a higher risk of poor outcome.
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Affiliation(s)
- Sebastian Sanchez
- Department of Neurosurgery, Thomas Jefferson University, United States
| | - Yesica Campos
- Department of Neurology, University of Alabama, United States
| | - Angel Cadena
- Department of Neurosurgery, Thomas Jefferson University, United States
| | - Sara Habib
- Department of Neurosurgery, Thomas Jefferson University, United States
| | | | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University, United States
| | - Matthew Vibbert
- Department of Neurosurgery, Thomas Jefferson University, United States
| | | | - M Kamran Athar
- Department of Neurosurgery, Thomas Jefferson University, United States
| | - Diana Tzeng
- Department of Neurology, Thomas Jefferson University, United States
| | - Lori Sheehan
- Department of Neurology, Thomas Jefferson University, United States
| | - Rodney Bell
- Department of Neurology, Thomas Jefferson University, United States
| | | | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, United States
| | | | - Fred Rincon
- Department of Neurosurgery, Thomas Jefferson University, United States; Department of Neurology, Thomas Jefferson University, United States.
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Swanson MB, Miller AC, Ward MM, Ullrich F, Merchant KA, Mohr NM. Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort. J Telemed Telecare 2019; 27:343-352. [PMID: 31684801 DOI: 10.1177/1357633x19877746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (a) identify the impact of telemedicine on emergency department (ED) stroke care, (b) identify if telemedicine impact varied by network and (c) describe the variation in process outcomes by telemedicine across EDs. METHODS A prospective cohort study identified stroke patients in four telemedicine networks between November 2015 and December 2017. Primary exposure was telemedicine consultation during ED evaluation. Outcomes included: (a) interpretation of computed tomography (CT) of the head within 45 minutes and (b) time to administer tissue plasminogen activator (tPA). An interaction term tested for differences in telemedicine effect on stroke care by network and hospital. RESULTS Of the 932 stroke subjects, 36% received telemedicine consults. For subjects with a last known well time within two hours of ED arrival (27.9%), recommended CT interpretation within 45 minutes was met for 66.8%. Telemedicine was associated with higher odds of timely head CT interpretation (adjusted odds ratio = 3.03; 95% confidence interval (CI) 1.69-5.46). The magnitude of the association between telemedicine and time to interpret a CT of the head differed between telemedicine networks (interaction term p = 0.033). Among eligible patients, telemedicine was associated with faster time to administer tPA (adjusted hazard ratio = 1.81; 95% CI 1.31-2.50). DISCUSSION Telemedicine consultation during the ED encounter decreased the time to interpret at CT of the head among stroke patients, with differing magnitudes of benefit across telemedicine networks. The effect of heterogeneity of telestroke affects across different networks should be explored in future analyses.
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Affiliation(s)
- Morgan B Swanson
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA.,Department of Epidemiology, Colleges of Medicine and Public Health, University of Iowa, Iowa City, IA, USA
| | - Aspen C Miller
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA
| | - Marcia M Ward
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Fred Ullrich
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Kimberly As Merchant
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA.,Department of Epidemiology, Colleges of Medicine and Public Health, University of Iowa, Iowa City, IA, USA.,Department of Anesthesia, Division of Critical Care, University of Iowa, Iowa City, IA, USA
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Expansion of Telemedicine Services: Telepharmacy, Telestroke, Teledialysis, Tele-Emergency Medicine. Crit Care Clin 2019; 35:519-533. [PMID: 31076051 DOI: 10.1016/j.ccc.2019.02.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As more specialized care gets centralized in centers of excellence, patients admitted to rural hospitals may be at a disadvantage at the time of accessing expertise or receiving advanced care. In this setting, telemedicine models provide a justification to equalize care across different levels. The diversity in telemedicine services is vast and is expanding. Even with all the subsets of telemedicine, including telepharmacy, telestroke, teledialysis, and tele-emergency medicine, the reasons for providing services and associated limitations are similar. However, there is a lack of empirical research including best practices and resultant outcomes for these subsets of telemedicine models.
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10
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Harpaz D, Eltzov E, Seet RCS, Marks RS, Tok AIY. Point-of-Care-Testing in Acute Stroke Management: An Unmet Need Ripe for Technological Harvest. BIOSENSORS 2017; 7:E30. [PMID: 28771209 PMCID: PMC5618036 DOI: 10.3390/bios7030030] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 12/20/2022]
Abstract
Stroke, the second highest leading cause of death, is caused by an abrupt interruption of blood to the brain. Supply of blood needs to be promptly restored to salvage brain tissues from irreversible neuronal death. Existing assessment of stroke patients is based largely on detailed clinical evaluation that is complemented by neuroimaging methods. However, emerging data point to the potential use of blood-derived biomarkers in aiding clinical decision-making especially in the diagnosis of ischemic stroke, triaging patients for acute reperfusion therapies, and in informing stroke mechanisms and prognosis. The demand for newer techniques to deliver individualized information on-site for incorporation into a time-sensitive work-flow has become greater. In this review, we examine the roles of a portable and easy to use point-of-care-test (POCT) in shortening the time-to-treatment, classifying stroke subtypes and improving patient's outcome. We first examine the conventional stroke management workflow, then highlight situations where a bedside biomarker assessment might aid clinical decision-making. A novel stroke POCT approach is presented, which combines the use of quantitative and multiplex POCT platforms for the detection of specific stroke biomarkers, as well as data-mining tools to drive analytical processes. Further work is needed in the development of POCTs to fulfill an unmet need in acute stroke management.
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Affiliation(s)
- Dorin Harpaz
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore.
- Institute for Sports Research (ISR), Nanyang Technology University and Loughborough University, Nanyang Avenue, Singapore 639798, Singapore.
| | - Evgeni Eltzov
- Agriculture Research Organization (ARO), Volcani Centre, Rishon LeTsiyon 15159, Israel.
| | - Raymond C S Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore.
| | - Robert S Marks
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore.
- The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
- The Ilse Katz Centre for Meso and Nanoscale Science and Technology, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
| | - Alfred I Y Tok
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore.
- Institute for Sports Research (ISR), Nanyang Technology University and Loughborough University, Nanyang Avenue, Singapore 639798, Singapore.
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