Telemedicine Can Replace the Neurologist on a Mobile Stroke Unit

Does no one ever look at results of stroke interventions? Having matching failures rates for tPA full efficacy of 12% is still a fucking failure. Who gives a shit if telemedicine is feasible if using it still leads to failure of results?
http://stroke.ahajournals.org/content/48/2/493?etoc=

Tzu-Ching Wu, Stephanie A. Parker, Amanda Jagolino, Jose-Miguel Yamal, Ritvij Bowry, Abraham Thomas, Amy Yu, James C. Grotta

https://doi.org/10.1161/STROKEAHA.116.015363

Stroke. 2017;48:493-496

Originally published January 12, 2017

• Article
• Figures & Tables
• Info & Metrics

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

---

Abstract

Background and Purpose—The BEST-MSU study (Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit) is a comparative effectiveness trial in patients randomized to mobile stroke unit or standard management. A substudy tested interrater agreement for tissue-type plasminogen activator eligibility between a telemedicine vascular neurologist and onboard vascular neurologist.

Methods—On scene, both the telemedicine vascular neurologist and onboard vascular neurologist independently evaluated the patient, documenting their tissue-type plasminogen activator treatment decision, National Institutes of Health Stroke Scale score, and computed tomographic interpretation. Agreement was determined using Cohen κ statistic. Telemedicine-related technical failures that impeded remote assessment were recorded.

Results—Simultaneous and independent telemedicine vascular neurologist and onboard vascular neurologist assessment was attempted in 174 patients. In 4 patients (2%), the telemedicine vascular neurologist could not make a decision because of technical problems. The telemedicine vascular neurologist agreed with the onboard vascular neurologist on 88% of evaluations (κ=0.73).

Conclusions—Remote telemedicine vascular neurologist assessment is reliable and accurate, supporting either telemedicine vascular neurologist or onboard vascular neurologist assessment on our mobile stroke unit.

Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT02190500.