Telestroke in Northern Alberta: a two year experience with remote hospitals.
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.


CONCLUSIONS
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.
Division of Neurology, Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada.
Khurshid
K
Khan
Ashfaq
A
Shuaib
Tammy
T
Whittaker
Maher
M
Saqqur
Thomas
T
Jeerakathil
Ken
K
Butcher
Patrick
P
Crumley
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D017216:Telemedicine / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D015898:Tomography Scanners, X-Ray Computed; D049269:Videoconferencing; D055815:Young Adult