title: Robotic telepresence versus standardly supervised stroke alert team assessments.
abstract: BACKGROUND
  Telemedicine has created access to emergency stroke care for patients in all communities, regardless of geography. We hypothesized that there is no difference in speed of assessment between vascular neurologist (VN) robotic telepresence and standard VN-supervised stroke alert patients in a metropolitan primary stroke center.
  
  
  METHODS
  A retrospective stroke alert database was used to identify all robotic telepresence and standardly supervised stroke alert patient assessments at a primary stroke center emergency department from 2009 to 2012. The primary outcome measure was the duration of assessment from stroke alert activation to treatment or downgrade.
  
  
  RESULTS
  The sample size was 196 subjects. The mean duration of time from stroke alert activation to initiation of intravenous (IV) thrombolytic treatment or downgrade was 8.6 min longer in the robotic group than in the standard group (p=0.03). Among the subgroup of acute ischemic stroke patients treated with IV thrombolysis, the mean duration of time from activation to treatment was 18 min longer in the robotic group than in the standard group (p=0.01). Safety outcomes including thrombolysis protocol violations (0% versus 1%), post-thrombolysis symptomatic intracranial hemorrhagic complications (3% versus 1%), and death during hospitalization (8% versus 6%) were low in the robotic group and not significantly different from that in the standard group.
  
  
  CONCLUSIONS
  Standard VN-supervised acute stroke team assessments were swifter than those supervised by robotic telepresence. Safety outcomes of robotic telepresence-supervised stroke alerts were excellent, and this modality may be preferred in circumstances when a VN is not immediately available on-site.
authors.affiliation: 1 Department of Neurology, Mayo Clinic , Phoenix, Arizona.
authors.forename: Cumara B
authors.initials: CB
authors.lastname: O'Carroll
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Hentz
authors.forename: Maria I
authors.initials: MI
authors.lastname: Aguilar
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001130:Arizona; D016009:Chi-Square Distribution; D004630:Emergencies; D004638:Emergency Treatment / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012371:Robotics; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D017216:Telemedicine / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: remote consultation; stroke; stroke management; telemedicine; telestroke; thrombolytic therapy; tissue plasminogen activator