title: Telestroke: rapid treatment of acute ischemic stroke patients using telemedicine in a Singapore emergency department.
abstract: OBJECTIVE
  In recent years, telemedicine technology has allowed hospitals without an in-house neurology service access to 24-h neurology consultation from specialized centers, thus paving the way for these hospitals to offer thrombolysis treatment for stroke patients. This article will describe the experience of the study hospital's emergency department (ED) in its use of telemedicine technology to facilitate the rapid treatment of acute ischemic stroke patients.
  
  
  METHODS
  The ED records, in-patient records, and paramedic records of all patients who presented to the study hospital's ED and received thrombolytic treatment for ischemic strokes were retrospectively reviewed.
  
  
  RESULTS
  From 25 October 2010 to 25 May 2011, using the telemedicine system, a total of 18 patients received thrombolytic treatment for acute ischemic strokes. The overall mean door to needle time was 92.7 min (95% CI 80.0 to 105.5), median 86.0 min. The mean onset of symptoms to needle (OTN) time was 154.9 min (95% CI 136.7 to 173.2), median 148 min. Factors such as presentation during office hours, brought in by ambulances as standby cases, and direct management by senior doctors were associated with shorter door to needle times.
  
  
  CONCLUSIONS
  Telemedicine is an invaluable tool that enables hospitals without 24-h onsite neurology service to offer emergency thrombolysis to eligible stroke patients, who otherwise will not be able to benefit from this therapy.
authors.affiliation: Department of Emergency Medicine, Changi General Hospital, Singapore, Singapore. baileylove@lycos.com
authors.forename: Seng H
authors.initials: SH
authors.lastname: Ang
authors.forename: Camlyn
authors.initials: C
authors.lastname: Tan
authors.forename: Rajinder
authors.initials: R
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D012846:Singapore; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D017216:Telemedicine; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator