An article published early online and in the September issue of Lancet Neurology compares telemedicine with telephone consultations for treatment in remote locations. Dr Brett C. Meyer (University of California San Diego School of Medicine Stroke Center, USA) and colleagues report that more accurate decisions are made in the important 3-hour window following stroke if physicians use telemedicine, not telephones, when treating victims who live outside of large cities.

Telemedicine incorporates real-time, two-way audio and video as well as digital imaging and communications. Meyer and colleagues conducted a prospective study in order to determine whether telemedicine or telephone communication would result in better decision-making outcomes during consultations in remote areas. The sample included 222 patients, older than 18 years, who from January 2004 to January 2007 presented at one of four remote sites in California. The patients were randomly assigned so that 111 received a telemedicine consultation and 111 received a telephone consultation for assessing their readiness for thrombolytic drug treatment. Effective treatment using thrombolytic drugs after stroke requires the expertise of skilled vascular neurologists. A stringent, multi-level central judging authority determined whether the decisions made by the remote physicians to give or not to give the drugs were correct or not.

The results of the study supported telemedicine as superior to telephone consultations. In 98% of telemedicine consultations and in 82% of telephone consultations, physicians made correct treatment decisions. Though more patients in the telemedicine group received thrombolytics than in the telephone group (31% vs. 25%), the difference was not statistically significant. In addition, the researchers found no statistical difference in rates of stroke recurrence or death. These results could, however, be a function of the small sample size or the fact that the study was halted and telephone consultations ceased because of the clear superiority of telemedicine in making treatment decisions.

"The results of this trial show that telemedicine is efficacious for making acute medical decisions. Stroke telemedicine is widely implemented and discussed, but despite its dissemination, its efficacy has not previously been shown. Our results support the use of telemedicine to make urgent treatment decisions, such as whether to use thrombolytic therapy for acute stroke," conclude the authors.

Dr Pierre Amarenco (Clinical Research in Atherothrombosis and Denis Diderot University, Bichat Stroke Centre, Paris, France) writes in an accompanying comment that in high-income countries, there is a massive difference in treatment received by people living in big cities and people in rural areas. "The next step is to show that telethrombolysis is equivalent to or better than the gold standard treatment to improve the percentage of patients with no handicap at three months. This would represent top level evidence for using and developing telemedicine for equal and improved access to alteplase in all patients with stroke. Such a study is currently recruiting patients in France...In the meantime, the study by Meyer and colleagues reinforces that telethrombolysis should be strongly preferred to telephone consultation," concludes Dr. Amarenco.

Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study
Brett C Meyer, Rema Raman, Thomas Hemmen, Richard Obler, Justin A Zivin, Ramesh Rao, Ronald G Thomas, Patrick D Lyden
The Lancet Neurology (2008).
Click Here to View Journal Web Site

: Peter M Crosta

Tag Cloud