title: Evaluation of a telephone advice system for remote intravenous thrombolysis in ischemic stroke: data from a United kingdom network.
abstract: OBJECTIVE
  There is limited evidence for remote stroke thrombolysis using telephone consultation and teleradiology. Results from a UK network using this treatment model are presented.
  
  
  METHODS
  Retrospective study of consecutive patients thrombolysed in 5 hospitals, with well organized stroke services, between 2012 and 2013. Remote thrombolysis was compared with thrombolysis delivered in person for symptomatic intracerebral hemorrhage, death within 7 days, and 90-day modified Rankin scores.
  
  
  RESULTS
  Of 586 patients, 220 (37.5%) were thrombolysed remotely. The 2 groups were well matched (median age 77 years, NIHSS 12). Remote thrombolysis increased treatment time by 22 minutes. Outcomes were no different in the 2 groups (remote versus standard): symptomatic intracerebral hemorrhage (3.6% versus 4.6%), death within 7 days (6.4% versus 7.1%), modified Rankin score <2 (46.0% versus 46.1%), and modified Rankin score 6 (15% versus 17.5%) at 90 days.
  
  
  CONCLUSIONS
  Telephone advice and teleradiology, within an organized system of care, can be an effective method of delivery of intravenous thrombolysis.
authors.affiliation: From the Stroke Department, Gloucestershire Royal Hospital, Gloucester, UK (D.D., K.H.); Emergency Department, Southmead Hospital, Bristol, UK (J.K.); Stroke Department, Bristol Royal Infirmary, Bristol, UK (C.H., P.M., S.C.); Stroke Department, Salisbury District Hospital, Salisbury, UK (T.B., D.W.); Stroke Department, Musgrove Park Hospital, Taunton, UK (R.W.); and Emergency Department, Great Western Hospital, Swindon, UK (K.A.). dipankar.dutta@glos.nhs.uk.
authors.forename: Dipankar
authors.initials: D
authors.lastname: Dutta
authors.affiliation: From the Stroke Department, Gloucestershire Royal Hospital, Gloucester, UK (D.D., K.H.); Emergency Department, Southmead Hospital, Bristol, UK (J.K.); Stroke Department, Bristol Royal Infirmary, Bristol, UK (C.H., P.M., S.C.); Stroke Department, Salisbury District Hospital, Salisbury, UK (T.B., D.W.); Stroke Department, Musgrove Park Hospital, Taunton, UK (R.W.); and Emergency Department, Great Western Hospital, Swindon, UK (K.A.).
authors.forename: Jason
authors.initials: J
authors.lastname: Kendall
authors.affiliation: From the Stroke Department, Gloucestershire Royal Hospital, Gloucester, UK (D.D., K.H.); Emergency Department, Southmead Hospital, Bristol, UK (J.K.); Stroke Department, Bristol Royal Infirmary, Bristol, UK (C.H., P.M., S.C.); Stroke Department, Salisbury District Hospital, Salisbury, UK (T.B., D.W.); Stroke Department, Musgrove Park Hospital, Taunton, UK (R.W.); and Emergency Department, Great Western Hospital, Swindon, UK (K.A.).
authors.forename: Clare
authors.initials: C
authors.lastname: Holmes
authors.affiliation: From the Stroke Department, Gloucestershire Royal Hospital, Gloucester, UK (D.D., K.H.); Emergency Department, Southmead Hospital, Bristol, UK (J.K.); Stroke Department, Bristol Royal Infirmary, Bristol, UK (C.H., P.M., S.C.); Stroke Department, Salisbury District Hospital, Salisbury, UK (T.B., D.W.); Stroke Department, Musgrove Park Hospital, Taunton, UK (R.W.); and Emergency Department, Great Western Hospital, Swindon, UK (K.A.).
authors.forename: Peter
authors.initials: P
authors.lastname: Murphy
authors.affiliation: From the Stroke Department, Gloucestershire Royal Hospital, Gloucester, UK (D.D., K.H.); Emergency Department, Southmead Hospital, Bristol, UK (J.K.); Stroke Department, Bristol Royal Infirmary, Bristol, UK (C.H., P.M., S.C.); Stroke Department, Salisbury District Hospital, Salisbury, UK (T.B., D.W.); Stroke Department, Musgrove Park Hospital, Taunton, UK (R.W.); and Emergency Department, Great Western Hospital, Swindon, UK (K.A.).
authors.forename: Toby
authors.initials: T
authors.lastname: Black
authors.affiliation: From the Stroke Department, Gloucestershire Royal Hospital, Gloucester, UK (D.D., K.H.); Emergency Department, Southmead Hospital, Bristol, UK (J.K.); Stroke Department, Bristol Royal Infirmary, Bristol, UK (C.H., P.M., S.C.); Stroke Department, Salisbury District Hospital, Salisbury, UK (T.B., D.W.); Stroke Department, Musgrove Park Hospital, Taunton, UK (R.W.); and Emergency Department, Great Western Hospital, Swindon, UK (K.A.).
authors.forename: Robert
authors.initials: R
authors.lastname: Whiting
authors.affiliation: From the Stroke Department, Gloucestershire Royal Hospital, Gloucester, UK (D.D., K.H.); Emergency Department, Southmead Hospital, Bristol, UK (J.K.); Stroke Department, Bristol Royal Infirmary, Bristol, UK (C.H., P.M., S.C.); Stroke Department, Salisbury District Hospital, Salisbury, UK (T.B., D.W.); Stroke Department, Musgrove Park Hospital, Taunton, UK (R.W.); and Emergency Department, Great Western Hospital, Swindon, UK (K.A.).
authors.forename: Kash
authors.initials: K
authors.lastname: Aujla
authors.affiliation: From the Stroke Department, Gloucestershire Royal Hospital, Gloucester, UK (D.D., K.H.); Emergency Department, Southmead Hospital, Bristol, UK (J.K.); Stroke Department, Bristol Royal Infirmary, Bristol, UK (C.H., P.M., S.C.); Stroke Department, Salisbury District Hospital, Salisbury, UK (T.B., D.W.); Stroke Department, Musgrove Park Hospital, Taunton, UK (R.W.); and Emergency Department, Great Western Hospital, Swindon, UK (K.A.).
authors.forename: Sarah
authors.initials: S
authors.lastname: Caine
authors.affiliation: From the Stroke Department, Gloucestershire Royal Hospital, Gloucester, UK (D.D., K.H.); Emergency Department, Southmead Hospital, Bristol, UK (J.K.); Stroke Department, Bristol Royal Infirmary, Bristol, UK (C.H., P.M., S.C.); Stroke Department, Salisbury District Hospital, Salisbury, UK (T.B., D.W.); Stroke Department, Musgrove Park Hospital, Taunton, UK (R.W.); and Emergency Department, Great Western Hospital, Swindon, UK (K.A.).
authors.forename: Kate
authors.initials: K
authors.lastname: Hellier
authors.affiliation: From the Stroke Department, Gloucestershire Royal Hospital, Gloucester, UK (D.D., K.H.); Emergency Department, Southmead Hospital, Bristol, UK (J.K.); Stroke Department, Bristol Royal Infirmary, Bristol, UK (C.H., P.M., S.C.); Stroke Department, Salisbury District Hospital, Salisbury, UK (T.B., D.W.); Stroke Department, Musgrove Park Hospital, Taunton, UK (R.W.); and Emergency Department, Great Western Hospital, Swindon, UK (K.A.).
authors.forename: David
authors.initials: D
authors.lastname: Walters
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D002309:Cardiology / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000188:drug therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: stroke; telemedicine; thrombolysis