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Telestroke in Northern Alberta: A Two Year Experience with Remote Hospitals

Published online by Cambridge University Press:  23 September 2016

Khurshid Khan ,
Ashfaq Shuaib ,
Tammy Whittaker ,
Maher Saqqur ,
Thomas Jeerakathil ,
Ken Butcher  and
Patrick Crumley
Khurshid Khan*
Affiliation:
Division of Neurology, Department of Medicine
Ashfaq Shuaib
Affiliation:
Division of Neurology, Department of Medicine
Tammy Whittaker
Affiliation:
University of Alberta Hospital, Edmonton
Maher Saqqur
Affiliation:
Division of Neurology, Department of Medicine
Thomas Jeerakathil
Affiliation:
Division of Neurology, Department of Medicine
Ken Butcher
Affiliation:
Division of Neurology, Department of Medicine
Patrick Crumley
Affiliation:
Northern Alberta Telestroke Program, Camrose, Alberta, Canada
*
2E3 WMC, Division of Neurology, University of Alberta Hospital, Edmonton, Alberta, T6G 2B7, Canada
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Abstract

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Background:

Thrombolysis in acute ischemic stroke is usually performed in comprehensive stroke centres. Lack of stroke expertise in remote small hospitals may preclude thrombolysis. Telemedicine allows such management opportunities in distant hospitals.

Methods:

We report our experience in managing acute stroke over a two-year time period with telestroke. The University of Alberta Hospital acted as the ‘hub’ and seven remote hospitals as ‘spoke’. The neurologist at the ‘hub’ provided stroke expertise to the local physician using either a two-way video link or telephone. Cranial CT scans were transmitted to ‘hub’. Education sessions were held before the initiation of the program.

Results:

Of 210 patients 44 (21%) received thrombolysis at the ‘spoke’ sites. In 34/44 (77%) two-way video link was available while in 10/44 (23%) telephone was used. Five (11.4%) patients experienced intracranial hemorrhage after thrombolysis, 2 (4.5%) were symptomatic. Favorable (mRS=0-1) outcome at three months was 16/40 (40%) and mortality was 9/40 (22.5%). Four patients were lost to follow-up. There was no significant three months outcome difference between two-way video link and telephone consultation (P = 0.689). Over two years the number of acute stroke transfers decreased from 144 to 15 at one of the ‘spoke’ sites, a 92.5% decline.

Conclusion:

It is possible to successfully treat patients with acute ischemic stroke at remote sites through videoconferencing or telephone consultation. Telestroke can also lead to a significant reduction in the number of patients requiring transfer to a tertiary care centre.

Résumé

RésuméContexte:

La thrombolyse dans l'accident vasculaire cérébral (AVC) ischémique aigu est habituellement effectuée dans des centres intégrés de soins de l'AVC. Le manque d'expertise dans le domaine de l'AVC dans les petits hôpitaux situés en région éloignée est un obstacle à la thrombolyse. La télémédecine permet d'y pallier dans les hôpitaux situés en région.

Méthodologie:

Nous rapportons notre expérience dans la prise en charge de l'AVC aigu au cours d'une période de deux ans au moyen de télé-AVC. Le University of Alberta Hôpital a agi comme noeud central et plusieurs hôpitaux situés en région comme sites satellites. Le neurologue du noeud central fournissait l'expertise en AVC au médecin local au moyen soit d'un lien vidéo à deux directions ou du téléphone. Les tomodensitométries cérébrales étaient transmises au noeud central. Des sessions de formation étaient tenues avant le début du programme.

Résultats:

Quarante-quatre (21%) des 210 patients ont reçu une thrombolyse dans les sites satellites. Pour 34 d'entre eux (77%), un lien vidéo à deux directions était disponible alors que pour 10 (23%) le téléphone a été utilisé. Cinq patients (11,4%) ont subi une hémorragie intracrânienne après la thrombolyse. Deux patients (4,5%) étaient asymptomatiques. Une issue favorable (mRS = 0 - 1) à trois mois a été observée chez 16 patients (40%) et la mortalité a été de 9 (22,5%). Quatre patients ont été perdus de vue. Il n'y avait pas de différence dans l'issue à 3 mois entre le lien vidéo à deux directions et la consultation par téléphone (p = 0,689). Sur une période de deux ans, le nombre de transferts de patients atteints d'AVC aigu a diminué de 144 à 15 à l'un des sites satellites, une diminution de 92,5%.

Conclusion:

Il est possible de traiter avec succès des patients atteints d'AVC ischémique aigu en région éloignée par vidéoconférence ou consultation téléphonique. Télé-AVC peut également entraîner une diminution significative du nombre de patients qui doivent être transférés à un centre de soins tertiaires.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 6 , November 2010 , pp. 808 - 813
Copyright
Copyright © The Canadian Journal of Neurological 2010

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