'Tele-Assessment' of Stroke Patients in Ambulance Saves Time

June 08, 2016

BARCELONA — Using video Internet technology that allows a stroke expert to assess possible stroke patients while they are being transported to hospital in the ambulance saves time and gets patients to imaging faster, a new study suggests.

The results are from the PRESSUB II trial, presented by Raf Brouns, MD, University Hospital Brussels, Belgium, at the recent European Stroke Organisation Conference (ESOC) 2016.

In the first randomized trial to evaluate such an approach, patients who were assessed by using the "tele" link in the ambulance underwent imaging at the hospital an average of 20 minutes earlier than those receiving standard care.

"Time is brain. Every minute saved is a couple of million neurons saved and increases the likelihood of a good outcome in patients treated with tPA [tissue plasminogen activator] or thrombectomy,” Dr Brouns commented to Medscape Medical News.

"We showed that this approach speeds up the diagnostic process,” he added. “You don't need to redo all this work at the hospital, so the relevant patients can be rushed straight to imaging. One of the goals of this approach could be to optimize prehospital triage for stroke patients so they are taken to the most appropriate stroke center if they are thought to be a suitable candidate for endovascular intervention."

For the study, 103 patients who were suspected of having had a stroke and were within 12 hours of symptom onset were randomly assigned to standard ambulance care or in-ambulance telestroke assessment. The emergency call dispatcher randomly assigned the patients after having decided that, according to their guidelines, the patient could be having a stroke.

Those randomly assigned to the "tele-assessment" approach were collected by an ambulance that had a photographic/video device on the ceiling so the remote stroke consultant could easily interact with the patient. Parameters assessed over the remote link included stroke severity, time of stroke onset, evolution of symptoms, comorbid symptoms, and concomitant medications.

"The goal is to differentiate between stroke and other conditions that may mimic stroke, and also to try to collect the necessary information for stroke patients. This saves time at the hospital," Dr Brouns explained.

Results showed that the primary efficacy endpoint — time from call to the emergency number to imaging — was reduced by an average of 20 minutes in the intervention group: 46 minutes vs 66 minutes (P = .001).

The primary safety endpoint — all-cause mortality at day 90 — was similar in both groups: 14.3% for the tele-assessment group and 15.6% for the standard care group (P = .775).

"We tried to do several assessments in the ambulance that are normally performed at the hospital to save time. Our results suggest that 'telestroke' consultation in the ambulance speeds up diagnostic processes with no increased risk, is technically reliable and organizationally feasible,” Dr Brouns concluded.

The current single-center study involved just one ambulance. "We hope to scale up for three or four ambulances within the next few weeks, and to conduct further multicenter clinical trials. Involvement of other centers outside trials is also a possibility," Dr Brouns said.

A different prehospital approach in stroke has been piloted in Berlin, Germany, and the Cleveland Clinic in Ohio, which involves the use of computed tomography (CT) and the administration of tPA in the ambulance.

"Our approach is much more simple," Dr Brouns pointed out. "It is also much less expensive than having a CT in the ambulance. This solution is very scalable — it can be used in multiple ambulances at the same time. It just seems like a common-sense thing to do."

Dr Brouns is a founder of a spin-off company from Universitair Ziekenhuis Brussel to commercialize telemedicine.

European Stroke Organisation Conference (ESOC) 2016. Abstract SC19. Presented May 12, 2016.

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