Efficacy of Telemedicine for Stroke: Pooled Analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona Telestroke Trials

Telemedicine and e-Health, 05/14/2012

This pooled analysis supports the hypothesis that stroke telemedicine consultations, compared with telephone–only, result in more accurate decision–making. Together with high rt–PA utilization rate, low post–rt–PA intracranial hemorrhage rate, and acceptable patient outcome, the results confirm that telemedicine is a viable consultative tool for acute stroke. The replication of the hub and spoke network infrastructure supports the generalizability of telemedicine when used in broader settings.

Methods

  • The study design is a pooled analysis of two identically designed randomized controlled trials conducted in a multistate hub and spoke telestroke network setting with acute stroke syndrome patients, comparing telemedicine versus telephone-only consultations.
  • From each trial, common data elements were pooled to assess, principally, for correctness of thrombolysis decision-making.
  • Secondary outcomes included rt-PA use rate, 90-day functional outcome, post-thrombolysis intracranial hemorrhage, and data completeness.

Results

  • Two hundred seventy-six pooled patients were evaluated.
  • Correct thrombolysis eligibility decisions were made more often with telemedicine (96% telemedicine, 83% telephone; odds ratio [OR] 4.2; 95% confidence interval [CI] 1.69-10.46; p=0.002).
  • Intravenous rt-PA usage was 26% (29% telemedicine, 24% telephone; OR 1.27; 95% CI 0.71–2.25; p=0.41).
  • Ninety-day outcomes were not different for Barthel Index, modified Rankin Scale, or mortality.
  • There was no difference in post-thrombolysis intracranial hemorrhage (8% telemedicine, 6% telephone; p>0.999).

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