title: Telemedicine in acute stroke: remote video-examination compared to simple telephone consultation.
abstract: BACKGROUND
  Telemedicine is increasingly being used in acute stroke care. Some of the first studies and network projects are already applying remote audiovisual communication for patient evaluation. Formerly the telephone was the method of choice to contact experts for case discussion. We compared remote video-examination and telephone consultation in acute stroke care.
  
  
  METHODS
  Two district hospitals were linked to stroke centers in Northern Bavaria. Patients with symptoms suggestive of an acute stroke were included. Remote video examination (RVE) was provided by live audiovisual communication and access to brain images; telephone consultation (TC) was done via standard telephone using a structured interview. There was a weekly rotation of the two methods. Demographic data and other data concerning process and quality of care as well as outcome 10 days after stroke were recorded and compared between the two groups.
  
  
  RESULTS
  Within the study period 151 consultations were made in acute stroke patients (mean age 66.8 years). 77 patients were seen by RVE and 74 by TC. Total examination times were 49.8 min for RVE and 27.2 min for TC (p < 0.01). Patients were more frequently transferred to the stroke center after TC consultation (9.1 % vs. 14.9 %, p < 0.05) and had a higher mortality 10 days after stroke (6.8 % vs. 1.3 %, p < 0.05). Diagnosis made by TC had to be corrected more frequently (17.6 % vs. 7.1 %; p < 0.05).
  
  
  CONCLUSIONS
  Creating a network improves stroke care by establishing cooperation between hospitals. Telephone consultation could be a simple method of telemedicine to support cooperation as it is easy and widely available. However, outcome parameters like mortality indicate that remote video examination is superior to TC. Therefore, full-scale audiovisual communication is recommended for remote consultation in acute stroke care.
authors.affiliation: Dept. of Neurology, Friedrich-Alexander-Universität, Schwabachanlage 6, 91054 Erlangen-Nürnberg, Germany. rene.handschu@uk-erlangen.de
authors.forename: René
authors.initials: R
authors.lastname: Handschu
authors.forename: Mateusz
authors.initials: M
authors.lastname: Scibor
authors.forename: Barbara
authors.initials: B
authors.lastname: Willaczek
authors.forename: Martin
authors.initials: M
authors.lastname: Nückel
authors.forename: Josef G
authors.initials: JG
authors.lastname: Heckmann
authors.forename: Dirk
authors.initials: D
authors.lastname: Asshoff
authors.forename: Dieter
authors.initials: D
authors.lastname: Belohlavek
authors.forename: Frank
authors.initials: F
authors.lastname: Erbguth
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019114:Remote Consultation / Q000379:methods*; D020521:Stroke / Q000175:diagnosis* / Q000401:mortality; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D049269:Videoconferencing; D055815:Young Adult