Telemedicine versus telephone for remote emergency stroke consultations: a critically appraised topic.
BACKGROUND
The rate of patients being treated with thrombolytic therapy is low, in part, due to a shortage of vascular neurologists, especially in rural communities. Two-way audio-video communication through telemedicine has been demonstrated to be a reliable method to assess neurologic deficits due to stroke and maybe more efficacious in determining thrombolytic therapy eligibility than telephone-only consultation.


OBJECTIVE
To determine the efficacy of telemedicine versus telephone-only consultations for decision making in acute stroke situations.


METHODS
The objective was addressed through the development of a structured, critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarian, and clinical content experts in the fields of vascular neurology, emergency medicine, and telemedicine. Participants started with a clinical scenario and a structured question, devised search strategies, located and compiled the best evidence, performed a critical appraisal, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions.


RESULTS
: A single randomized, blinded, prospective trial comparing telephone-only consultations to telemedicine consultations for acute stroke was selected and appraised. Correct acute stroke treatment decisions were made more often in the telemedicine group versus the telephone-only group (98% vs. 82%, [number needed to assess = 6]). Stroke telemedicine when compared with telephone-only consultations was more sensitive (100% vs. 58%), more specific (98% vs. 92%), had a more favorable positive likelihood ratio (LR: 41 vs. 7) and negative likelihood ratio (LR: 0 vs. 0.5), and had higher predictive values (positive predictive value 94% vs. 76%, and negative predictive value 100% vs. 84%) for the determination of thrombolysis eligibility.


CONCLUSIONS
Stroke telemedicine when compared with telephone-only consultations is an effective method to determine thrombolysis eligibility for acute stroke patients who do not have immediate access to a stroke neurologist.
Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA.
Dan J
DJ
Capampangan
Kay E
KE
Wellik
Bentley J
BJ
Bobrow
Maria I
MI
Aguilar
Timothy J
TJ
Ingall
Terri-Ellen
TE
Kiernan
Dean M
DM
Wingerchuk
Bart M
BM
Demaerschalk
D000368:Aged; D003657:Decision Making; D004632:Emergency Medical Services; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016239:MEDLINE; D009462:Neurology; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation; D019114:Remote Consultation / Q000379:methods*; D020521:Stroke / Q000175:diagnosis / Q000628:therapy; D017216:Telemedicine / Q000706:statistics & numerical data*; D013689:Telephone / Q000706:statistics & numerical data*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome