title: Impact of telemedicine implementation in thrombolytic use for acute ischemic stroke: the University of Pittsburgh Medical Center telestroke network experience.
abstract: BACKGROUND
  Intravenous thrombolysis is the only therapy for acute ischemic stroke that is approved by the US Food and Drug Association. The use of telemedicine in stroke makes it possible to bring the expertise of academic stroke centers to underserved areas, potentially increasing the quality of stroke care.
  
  
  METHODS
  All consecutive admissions for stroke were reviewed for 1 year before telemedicine implementation and for variable periods thereafter. A retrospective review identified 2588 admissions for acute stroke between March 2005 and December 2008 at 12 hospitals participating in a telestroke network, including 919 patients before telemedicine was available and 1669 patients after telemedicine was available. The primary outcome measure was the rate of intravenous tissue plasminogen activator (IV tPA) use before and after telemedicine implementation.
  
  
  RESULTS
  One hundred thirty-nine patients received IV tPA in both study phases, with 26 (2.8%) patients treated before starting telemedicine and 113 (6.8%) after starting telemedicine (P < .001). Incorrect treatment decisions occurred 7 times (0.39%), with 2 (0.2%) pretelemedicine and 5 (0.3%) posttelemedicine (P = .70). Arrivals within 3 hours from symptom onset were more frequent in the posttelemedicine compared to the pretelemedicine phases (55 [6%] vs 159 [9.5%]; P = .002). Among the patients treated with IV tPA, symptomatic intracranial hemorrhage occurred in 2 patients (1 [10.7%] pretelemedicine vs 1 [1.8%] posttelemedicine; P = .34).
  
  
  CONCLUSIONS
  Telestroke implementation was associated with an increased rate of thrombolytic use in remote hospitals within the telemedicine network.
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Edilberto
authors.initials: E
authors.lastname: Amorim
authors.forename: Min-Mei
authors.initials: MM
authors.lastname: Shih
authors.forename: Steven A
authors.initials: SA
authors.lastname: Koehler
authors.forename: Lori L
authors.initials: LL
authors.lastname: Massaro
authors.forename: Syed F
authors.initials: SF
authors.lastname: Zaidi
authors.forename: Mouhammad A
authors.initials: MA
authors.lastname: Jumaa
authors.forename: Vivek K
authors.initials: VK
authors.lastname: Reddy
authors.forename: Maxim D
authors.initials: MD
authors.lastname: Hammer
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Wechsler
mesh_terms: D000046:Academic Medical Centers; D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D016009:Chi-Square Distribution; D003695:Delivery of Health Care; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006297:Health Services Accessibility; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D011237:Predictive Value of Tests; D015397:Program Evaluation; D019114:Remote Consultation; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D017216:Telemedicine; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome; D049269:Videoconferencing
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator