REACH: clinical feasibility of a rural telestroke network.
OBJECTIVE
Development of stroke networks is critical to bringing guideline-driven stroke care to rural, underserved areas.


METHODS
A Web-based telestroke tool, REACH, was developed to provide a foundation for a rural stroke network that delivered acute stroke consults 24 hours per day 7 days per week to 8 rural community hospitals in Georgia.


RESULTS
There were 194 acute stroke consults delivered. Thirty patients were treated with tissue plasminogen activator (tPA). The mean National Institutes of Health Stroke Score (NIHSS) was 15.4, and the median NIHSS was 12.5. The mean onset to treatment time (OTT) was 122 minutes. The OTT dropped from 143 minutes in the first 10 patients treated to 111 minutes in last 20 patients. Of the 30 patients treated with tPA, 23% (7) were treated in < or =90 minutes and 60% (18) were treated within 2 hours. There were no symptomatic intracerebral hemorrhages.


CONCLUSIONS
The REACH telestroke system permits the rapid and safe use of tPA in rural community hospitals. Over time, the system became more efficient and OTT decreased.
Hess
David C
DC
Department of Neurology, Medical College of Georgia, Augusta, GA 30912, USA. dhess@mail.mcg.edu
Wang
Samuel
S
Hamilton
William
W
Lee
Sung
S
Pardue
Carol
C
Waller
Jennifer L
JL
Gross
Hartmut
H
Nichols
Fenwick
F
Hall
Christiana
C
Adams
Robert J
RJ
D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005845:Georgia; D006764:Hospitals, Community; D006780:Hospitals, Rural; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D019114:Remote Consultation / Q000379:methods*; D012424:Rural Population; D020521:Stroke / Q000628:therapy*; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D049269:Videoconferencing
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator