COMMENTARY

Telemedicine Is Crucial to Implementing Acute Stroke Therapy

Sean I. Savitz, MD

Disclosures

February 06, 2006

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Telemedicine is crucial to providing timely therapy for acute stroke at community hospitals. There's only 1 FDA-approved drug for stroke: tPA. But many people who are treated for acute ischemic stroke at community hospitals don't get it.[1,2] Why not? Well, according to FDA guidelines, tPA can only be given within 3 hours of symptom onset. Physicians at local hospitals may be untrained in administering tPA or uncomfortable with it. Many hospitals don't have round-the-clock access to neurologists. By the time a patient can be moved to a center equipped for 24/7 acute stroke care, it may be too late for tPA treatment.[3,4] Yet administering tPA at local hospitals is critical, because the earlier treatment is initiated, the higher the probability for a better outcome.[5]

Some medical centers without on-site stroke expertise are using telemedicine. Two-way videoconferencing allows stroke experts to see the patient and interact with physicians at local hospitals. Stroke physicians can guide local emergency physicians to perform a neurological evaluation, rapidly review imaging, and discuss treatment options, including tPA. Several pilot studies throughout the country have demonstrated that telemedicine-guided tPA therapy is safe and feasible.[6,7,8] Such an approach has led to the administration of tPA in patients who in the past would not have been treated without a telemedicine network.[8,9]

Given the devastating outcomes from stroke, every community hospital in this country should either develop a stroke center[10] or partner with medical centers that have stroke expertise, using telemedicine as a bridge to direct stroke care.

That's my opinion. I'm Dr. Sean Savitz, Instructor in Neurology, Harvard Medical School, and Attending Neurologist at Beth Israel Deaconess Medical Center.


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