Skip to main content
SpringerLink
Log in

Telemedicine in Stroke Systems of Care

  • Chapter
Ischemic Stroke Therapeutics

  • 2160 Accesses

Abstract

Acute ischemic stroke is a public health crisis in the USA and around the world. A concerted effort has been made to apply best practices to ischemic stroke care with the goal of improving post-stroke outcomes. However, geography, distance, time, and stroke expert personnel shortages contribute to disparities in access to stroke care, especially among a significant proportion of the population that lives beyond the immediate reach of an acute stroke-ready hospital, primary stroke center, or comprehensive stroke center. In an attempt to address this rural- to metropolitan disparity and expand the availability of best stroke practices, Levine and Gorman proposed the development of telemedical outreach for acute stroke evaluation and management, which they called “telestroke.” Since that time, evidence supporting telestroke has been published, which demonstrated excellent interrater and intrarater agreement of the National Institutes of Health Stroke Scale (NIHSS) score between telemedicine-enabled versus bedside assessment, increased correct thrombolysis decision making by telestroke as compared to telephone-only consultation, and cost-effectiveness of the telestroke model from a hospital as well as from a societal perspective. As a consequence of these health care delivery research discoveries and the recognition of clinical benefit by stroke providers, patients, and family, telestroke networks have expanded rapidly in the USA and beyond. Additional research is necessary to more clearly understand the potential benefits of the telestroke infrastructure for other phases of stroke care including prehospital emergency medical systems, post-stroke hospitalization, rehabilitation, repatriation, reintegration into the community, avoidance of readmission to hospital, reduction of complications, prevention of recurrent stroke, and education of patients, family, and health providers.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics–2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–220.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Brundtland GH. From the World Health Organization. Reducing risks to health, promoting healthy life. JAMA. 2002;288(16):1974.

    Article  PubMed  Google Scholar 

  3. Lichtman JH, Allen NB, Wang Y, Watanabe E, Jones SB, Goldstein LB. Stroke patient outcomes in US hospitals before the start of the Joint Commission Primary Stroke Center certification program. Stroke. 2009;40(11):3574–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Fonarow GC, Gregory T, Driskill M, Stewart MD, et al. Hospital certification for optimizing cardiovascular disease and stroke quality of care and outcomes. Circulation. 2010;122(23):2459–69.

    Article  PubMed  Google Scholar 

  5. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995;333(24):1581–7.

    Google Scholar 

  6. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317–29.

    Article  CAS  PubMed  Google Scholar 

  7. Saver JL, Fonarow GC, Smith EE, et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA. 2013;309(23):2480–8.

    Article  CAS  PubMed  Google Scholar 

  8. Donnan GA, Davis SM. Neurologist, internist, or strokologist? Stroke. 2003;34(11):2765.

    Article  PubMed  Google Scholar 

  9. Goldstein LB, Matchar DB, Hoff-Lindquist J, Samsa GP, Horner RD. VA Stroke Study: neurologist care is associated with increased testing but improved outcomes. Neurology. 2003;61(6):792–6.

    Article  CAS  PubMed  Google Scholar 

  10. Smith MA, Liou JI, Frytak JR, Finch MD. 30-day survival and rehospitalization for stroke patients according to physician specialty. Cerebrovasc Dis. 2006;22(1):21–6.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Levine SR, Gorman M. “Telestroke”: the application of telemedicine for stroke. Stroke. 1999;30(2):464–9.

    Article  CAS  PubMed  Google Scholar 

  12. Demaerschalk BM, Vegunta S, Vargas BB, Wu Q, Channer DD, Hentz JG. Reliability of real-time video smartphone for assessing National Institutes of Health Stroke Scale scores in acute stroke patients. Stroke. 2012;43(12):3271–7.

    Article  PubMed  Google Scholar 

  13. Shafqat S, Kvedar JC, Guanci MM, Chang Y, Schwamm LH. Role for telemedicine in acute stroke. Feasibility and reliability of remote administration of the NIH stroke scale. Stroke. 1999;30(10):2141–5.

    Article  CAS  PubMed  Google Scholar 

  14. Wang S, Lee SB, Pardue C, Ramsingh D, Waller J, Gross H, et al. Remote evaluation of acute ischemic stroke: reliability of National Institutes of Health Stroke Scale via telestroke. Stroke. 2003;34(10):e188–91.

    Article  PubMed  Google Scholar 

  15. Demaerschalk BM, Bobrow BJ, Raman R, Kiernan TE, Aguilar MI, Ingall TJ, et al. Stroke team remote evaluation using a digital observation camera in Arizona: the initial mayo clinic experience trial. Stroke. 2010;41(6):1251–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Demaerschalk BM, Raman R, Ernstrom K, Meyer BC. Efficacy of telemedicine for stroke: pooled analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona telestroke trials. Telemed J E Health. 2012;18(3):230–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Meyer BC, Raman R, Hemmen T, Obler R, Zivin JA, Rao R, et al. Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. Lancet Neurol. 2008;7(9):787–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Nelson RE, Saltzman GM, Skalabrin EJ, Demaerschalk BM, Majersik JJ. The cost-effectiveness of telestroke in the treatment of acute ischemic stroke. Neurology. 2011;77(17):1590–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Switzer JA, Demaerschalk BM, Xie J, Fan L, Villa KF, Wu EQ. Cost-effectiveness of hub-and-spoke telestroke networks for the management of acute ischemic stroke from the hospitals’ perspectives. Circ Cardiovasc Qual Outcomes. 2013;6(1):18–26.

    Article  PubMed  Google Scholar 

  20. Demaerschalk BM, Switzer JA, Xie F, Fan L, Villa KF, Wu EQ. Cost utility of hub-and-spoke telestroke networks from societal perspective. Am J Manag Care. 2013;19(12):976–85.

    PubMed  Google Scholar 

  21. George BP, Scoglio NJ, Reminick JI, et al. Telemedicine in leading US neurology departments. Neurohospitalist. 2012;2(3):123–8.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Silva GS, Farrell S, Shandra E, Viswanathan A, Schwamm LH. The status of telestroke in the United States: a survey of currently active stroke telemedicine programs. Stroke. 2012;43(8):2078–85.

    Article  PubMed  Google Scholar 

  23. Demaerschalk BM, Miley ML, Kiernan TE, et al. Stroke telemedicine. Mayo Clin Proc. 2009;84(1):53–64.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rubin MN, Wellik KE, Channer DD, Demaerschalk BM. Systematic review of telestroke for post-stroke care and rehabilitation. Curr Atheroscler Rep. 2013;15(8):343.

    Article  PubMed  Google Scholar 

  25. Rubin MN, Wellik KE, Channer DD, Demaerschalk BM. A systematic review of telestroke. Postgrad Med. 2013;125(1):45–50.

    Article  PubMed  Google Scholar 

  26. Schwamm LH, Holloway RG, Amarenco P, Audebert HJ, Bakas T, Chumbler NR, et al. A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2009;40(7):2616–34.

    Article  PubMed  Google Scholar 

  27. Schwamm LH, Audebert HJ, Amarenco P, et al. Recommendations for the implementation of telemedicine within stroke systems of care: a policy statement from the American Heart Association. Stroke. 2009;40(7):2635–60.

    Article  PubMed  Google Scholar 

  28. Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947.

    Article  PubMed  Google Scholar 

  29. Handschu R, Littmann R, Reulbach U, et al. Telemedicine in emergency evaluation of acute stroke: interrater agreement in remote video examination with a novel multimedia system. Stroke. 2003;34(12):2842–6.

    Article  PubMed  Google Scholar 

  30. Audebert HJ, Boy S, Jankovits R, Pilz P, Klucken J, Fehm NP, et al. Is mobile teleconsulting equivalent to hospital-based telestroke services? Stroke. 2008;39(12):3427–30.

    Article  PubMed  Google Scholar 

  31. Anderson ER, Smith B, Ido M, Frankel M. Remote assessment of stroke using the iPhone 4. J Stroke Cerebrovasc Dis. 2013;22(4):340–4.

    Article  PubMed  Google Scholar 

  32. Gonzalez MA, Hanna N, Rodrigo ME, Satler LF, Waksman R. Reliability of prehospital real-time cellular video phone in assessing the simplified National Institutes of Health Stroke Scale in patients with acute stroke: a novel telemedicine technology. Stroke. 2011;42(6):1522–7.

    Article  PubMed  Google Scholar 

  33. LaMonte MP, Cullen J, Gagliano DM, Gunawardane R, Hu P, Mackenzie C, et al. TeleBAT: mobile telemedicine for the Brain Attack Team. J Stroke Cerebrovasc Dis. 2000;9(3):128–35.

    Article  CAS  PubMed  Google Scholar 

  34. LaMonte MP, Xiao Y, Hu PF, et al. Shortening time to stroke treatment using ambulance telemedicine: TeleBAT. J Stroke Cerebrovasc Dis. 2004;13(4):148–54.

    Article  PubMed  Google Scholar 

  35. Ebinger M, Rozanski M, Waldschmidt C, et al. PHANTOM-S: the prehospital acute neurological therapy and optimization of medical care in stroke patients—study. Int J Stroke. 2012;7(4):348–53.

    Article  PubMed  Google Scholar 

  36. Liman TG, Winter B, Waldschmidt C, et al. Telestroke ambulances in prehospital stroke management: concept and pilot feasibility study. Stroke. 2012;43(8):2086–90.

    Article  PubMed  Google Scholar 

  37. Weber JE, Ebinger M, Rozanski M, et al. Prehospital thrombolysis in acute stroke: results of the PHANTOM-S pilot study. Neurology. 2013;80(2):163–8.

    Article  CAS  PubMed  Google Scholar 

  38. Mikulik R, Alexandrov AV, Ribo M, et al. Telemedicine-guided carotid and transcranial ultrasound: a pilot feasibility study. Stroke. 2006;37(1):229–30.

    Article  CAS  PubMed  Google Scholar 

  39. Brennan DM, Georgeadis AC, Baron CR, Barker LM. The effect of videoconference-based telerehabilitation on story retelling performance by brain-injured subjects and its implications for remote speech-language therapy. Telemed J E Health. 2004;10(2):147–54.

    Article  PubMed  Google Scholar 

  40. Frey JL, Jahnke HK, Goslar PW, Partovi S, Flaster MS. tPA by telephone: extending the benefits of a comprehensive stroke center. Neurology. 2005;64(1):154–6.

    Article  CAS  PubMed  Google Scholar 

  41. Singh R, Ng WH, Lee KE, Wang E, Ng I, Lee WL. Telemedicine in emergency neurological service provision in Singapore: using technology to overcome limitations. Telemed J E Health. 2009;15(6):560–5.

    Article  PubMed  Google Scholar 

  42. Switzer JA, Demaerschalk BM. Overcoming challenges to sustain a telestroke network. J Stroke Cerebrovasc Dis. 2012;21(7):535–40.

    Article  PubMed  Google Scholar 

  43. Fanale CV, Demaerschalk BM. Telestroke network business model strategies. J Stroke Cerebrovasc Dis. 2012;21(7):530–4.

    Article  PubMed  Google Scholar 

  44. Rubin MN, Wellik KE, Channer DD, Demaerschalk BM. Role of telemedicine in providing tertiary neurological care. Curr Treat Options Neurol. 2013;15(5):567–82.

    Article  PubMed  Google Scholar 

  45. Bladin CF, Cadilhac DA. Effect of telestroke on emergent stroke care and stroke outcomes. Stroke. 2014;45(6):1876–80.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, USA

    Bart Demaerschalk M.D., M.Sc.

Authors
  1. Bart Demaerschalk M.D., M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bart Demaerschalk M.D., M.Sc. .

Editor information

Editors and Affiliations

  1. Admiral Pihl Professor and Chairman of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA

    Bruce Ovbiagele

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Demaerschalk, B. (2016). Telemedicine in Stroke Systems of Care. In: Ovbiagele, B. (eds) Ischemic Stroke Therapeutics. Springer, Cham. https://doi.org/10.1007/978-3-319-17750-2_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17750-2_30

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17749-6

  • Online ISBN: 978-3-319-17750-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation