NEW YORK -- August 4, 2008 -- Use of stroke telemedicine consultations result in more accurate decision making compared with telephone consultations in remote locations, according to a study published early online and in the September issue of Lancet Neurology.
Telemedicine could help deliver vital treatment to people who live outside large cities, within the 3-hour treatment window that follows a stroke.
Brett C. Meyer, MD, University of California, San Diego, School of Medicine Stroke Center, San Diego, California, and colleagues assessed whether telemedicine or telephone was superior for decision making in acute telemedicine consultations.
From January 2004 to January 2007, patients (N = 222) aged 18 years and older were randomly assigned to telemedicine (n = 111) or telephone consultation (n = 111) to assess their suitability for treatment with thrombolytic drugs.
Whether the decision to give or not give these drugs was correct was then decided through a stringent, multi-level central adjudication.
The researchers found that correct treatment decisions were made in 98% of telemedicine consultations versus 82% of telephone consultations. More patients in the telemedicine group (31%) were given thrombolytics than in the telephone group (25%), although the results were not statistically significantly different.
After 3 months there was no difference in rates of stroke recurrence or mortality, but the authors suggest this could be because the trial did not study a sufficient number of patients to determine such a difference. The study was halted early because of clear benefit of telemedicine regarding 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," the authors wrote.
"Our results support the use of telemedicine to make urgent treatment decisions, such as whether to use thrombolytic therapy for acute stroke."
SOURCE: The Lancet
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