Is mobile teleconsulting equivalent to hospital-based telestroke services?
OBJECTIVE
Telemedicine is increasingly used to provide acute stroke expertise for hospitals without full-time neurological services. Teleconsulting through mobile laptop computers may offer more flexibility compared with hospital-based services, but concerns about quality and technical reliability remain.


METHODS
We conducted a controlled trial, allocating hospital-based or mobile teleconsulting in a shift-by-shift sequence and evaluating technical parameters, acceptability, and impact on immediate clinical decisions. Both types of telemedicine workstations were equipped with DICOM (Digital-Imaging-and-Communications-in-Medicine) viewer and videoconference software. The laptop connected by asymmetrical broadband UMTS (Universal-Mobile-Telecommunication-Systems) technology with a one-way spoke-to-hub video transmission, whereas the hospital-based device used landline symmetrical telecommunication, including a 2-way videoconference.


RESULTS
One hundred twenty-seven hospital-based and 96 mobile teleconsultations were conducted within 2 months without any technical breakdown. The rates per allocated time were similar with 3.8 and 4.0 per day. No significant differences were found for durations of videoconference (mean: 11+/-3 versus 10+/-3 minutes, P=0.07), DICOM download (3+/-3 versus 4+/-3 minutes, P=0.19), and total duration of teleconsultations (44+/-19 versus 45+/-21 minutes, P=0.98). Technical quality of mobile teleconsultations was rated worse on both sides, but this did not affect the ability to make remote clinical decisions like initiating thrombolysis (17% versus 13% of all, P=0.32).


CONCLUSIONS
Teleconsultation using a laptop workstation and broadband mobile telecommunication was technically stable and allowed remote clinical decision-making. There remain disadvantages regarding videoconference quality on the hub side and lack of video transmission to the spoke side.
Audebert
Heinrich J
HJ
Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Germany. heinrich.audebert@charite.de
Boy
Sandra
S
Jankovits
Ralf
R
Pilz
Philipp
P
Klucken
Jochen
J
Fehm
Nando P
NP
Schenkel
Johannes
J
D040421:Cell Phone; D003195:Computer Communication Networks / Q000458:organization & administration*; D003199:Computer Systems; D005060:Europe; D005240:Feasibility Studies; D006782:Hospitals, Special / Q000458:organization & administration*; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D008838:Microcomputers; D019114:Remote Consultation / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data; D012984:Software; D020521:Stroke / Q000628:therapy*; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data; D049269:Videoconferencing / Q000706:statistics & numerical data