| Telemedicine for acute stroke: triumphs and pitfalls. | |
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MedLine Citation:
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PMID: 12624298 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Telemedicine is emerging as a potential timesaving, efficient means for evaluating patients experiencing acute stroke. In areas where local stroke care specialists are not available, telemedicine can link an emergency department physician with a specialist in a stroke treatment center. This consultation provides an opportunity for administration of thrombolytic drugs within the short therapeutic time window associated with ischemic stroke. Here, we describe our stroke treatment center experiences and report safe administration of recombinant tissue plasminogen activator (rtPA) during telemedicine consultation. METHODS: The University of Maryland Medical Center uses a triplexed integrated services digital network line providing a 30--frames-per-second video link to St Mary's Hospital >100 miles away. The system uses a pan, tilt, and zoom camera with remote site control, allowing 2-way, real-time, audiovisual communication and CT image transfer. We retrospectively reviewed all acute stroke consultations provided to St Mary's Hospital between 1999 and 2001. RESULTS: We reviewed 50 consultations. Of the 50, 23 were attempted through telemedicine linkage, and 27 were by traditional telephone conversation, followed by transfer. Of the 23 telemedicine consultations, 2 were aborted because of technical difficulties. Of the patients evaluated by traditional means, 1 of 27 (3.8%) received intravenous rtPA; 5 of 21 (23.8%) received rtPA after telemedicine consultation. No patients experienced complications. CONCLUSIONS: Telemedicine consultation provided treatment options not previously available at the remote hospital. Administration of rtPA during telemedicine consultation was feasible and safe, and the system was well received. Lack of reimbursement for telemedicine services will hinder widespread adaptation of this promising technology for remote acute stroke treatment. |
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Authors:
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Marian P LaMonte; Mona N Bahouth; Peter Hu; Mohammed Y Pathan; Karen L Yarbrough; Ruwani Gunawardane; Patrick Crarey; Wesley Page |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2003-01-30 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 34 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2003 Mar |
Date Detail:
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Created Date: 2003-03-07 Completed Date: 2003-03-31 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 725-8 Citation Subset: IM |
Affiliation:
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Department of Neurology, University of Maryland Medicine, 22 S Greene St, Room N4W46, Baltimore MD 21201, USA. mlamonte@som.umaryland.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Academic Medical Centers
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organization & administration* Feasibility Studies Fibrinolytic Agents / therapeutic use Hospitals, Community / organization & administration* Humans Maryland Organizational Case Studies Patient Satisfaction Process Assessment (Health Care) / statistics & numerical data* Remote Consultation* / economics, instrumentation, methods, trends Retrospective Studies Sample Size Stroke / diagnosis*, drug therapy Telephone / statistics & numerical data Tissue Plasminogen Activator / adverse effects, therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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