And yet even good stuff like this prevents us from researching objective diagnosis of stroke fast, quick and easy with no neurologist intervention. That should be the goal, not just speeding up existing procedures. These people just do not want to solve BHAGs(Big Hairy Audacious Goals)
Too bad, I bet someone solving that would be in line for a Nobel.
http://www.medscape.com/viewarticle/864512?src=wnl_edit_tpal&uac=234561MY?src=soc_tw_share
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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