|Title||Telemedicine versus telephone for remote emergency stroke consultations: a critically appraised topic.|
|Publication Type||Journal Article|
|Year of Publication||2009|
|Authors||Capampangan DJ, Wellik KE, Bobrow BJ, Aguilar MI, Ingall TJ, Kiernan T-E, Wingerchuk DM, Demaerschalk BM|
|Date Published||2009 May|
|Keywords||Aged, Decision Making, Emergency Medical Services, Evidence-Based Medicine, Female, Humans, MEDLINE, Neurology, Randomized Controlled Trials as Topic, Referral and Consultation, Remote Consultation, Stroke, Telemedicine, Telephone, Thrombolytic Therapy, Treatment Outcome|
BACKGROUND: The rate of patients being treated with thrombolytic therapy is low, in part, due to a shortage of vascular neurologists, especially in rural communities. Two-way audio-video communication through telemedicine has been demonstrated to be a reliable method to assess neurologic deficits due to stroke and maybe more efficacious in determining thrombolytic therapy eligibility than telephone-only consultation.
OBJECTIVE: To determine the efficacy of telemedicine versus telephone-only consultations for decision making in acute stroke situations.
METHODS: The objective was addressed through the development of a structured, critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarian, and clinical content experts in the fields of vascular neurology, emergency medicine, and telemedicine. Participants started with a clinical scenario and a structured question, devised search strategies, located and compiled the best evidence, performed a critical appraisal, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions.
RESULTS: : A single randomized, blinded, prospective trial comparing telephone-only consultations to telemedicine consultations for acute stroke was selected and appraised. Correct acute stroke treatment decisions were made more often in the telemedicine group versus the telephone-only group (98% vs. 82%, [number needed to assess = 6]). Stroke telemedicine when compared with telephone-only consultations was more sensitive (100% vs. 58%), more specific (98% vs. 92%), had a more favorable positive likelihood ratio (LR: 41 vs. 7) and negative likelihood ratio (LR: 0 vs. 0.5), and had higher predictive values (positive predictive value 94% vs. 76%, and negative predictive value 100% vs. 84%) for the determination of thrombolysis eligibility.
CONCLUSION: Stroke telemedicine when compared with telephone-only consultations is an effective method to determine thrombolysis eligibility for acute stroke patients who do not have immediate access to a stroke neurologist.
Telemedicine versus telephone for remote emergency stroke consultations: a critically appraised topic.
Bentley J. Bobrow, MD, FACEP, FAHA