Acute stroke assessment with telemedicine: does it affect time to treatment and outcome compared with face-to-face assessment?

Background and Aims: Outcomes for stroke patients are improved by reducing time to, and increasing accessibility of, stroke-specialist consultation and treatments (e.g. delivery of thrombolysis). Telemedicine is a way that this can be facilitated, especially outside routine working hours. This study compared the timeliness of treatment and short-term patient outcomes when telemedicine or face-to-face assessment was used as part of the decision process of administering thrombolysis to patients affected by stroke. Method: Stroke data from SINAP and DASH databases between July 2011 and March 2013 was provided from six trusts in Lancashire and Cumbria which used telemedicine for the assessment of acute stroke, and eleven trusts within the North East of England which assessed patients face-to-face. Data was analysed from 220 stroke patients who received thrombolysis; this was restricted to those admitted out-of-hours as this was when telemedicine would normally be used. Results: The results showed that stroke patients assessed via telemedicine had a subsequent longer door-to needle time in comparison to those assessed via traditional face-to-face methods (95%CI: -32.43 to -11.15 minutes). Also, no significant differences were found between telemedicine and face-to-face assessments on patient outcomes such as length of stay in hospital (95%CI: -10.29 to 3.23 days), stay in stroke unit (95%CI: -10.42 to 3.01 days), rate of complications (OR 95%CI: 0.33 to 1.82) or discharge destination (OR 95%CI: 0.30 to 1.11). Conclusion: Patients assessed by telemedicine have a longer door-toneedle time than those assessed face-to-face. However, whether assessment was via telemedicine or face-to-face does not appear to affect short-term patient outcomes.