title: Telephone and Teleradiology-Guided Thrombolysis Can Achieve Similar Outcome as Thrombolysis by Neurologist On-site.
abstract: BACKGROUND
  Because of the limitation of on-site neurology workforce, telestroke was implemented to overcome this barrier. We explored the efficacy and safety of intravenous (IV) stroke thrombolysis service by telestroke when neurologist was not available on-site.
  
  
  METHODS
  From January 2009 to December 2012, we compared patients treated with IV stroke thrombolysis by telestroke in the form of telephone consultation with teleradiology, to patients treated after in-person assessment by the same team of neurologists in a regional hospital. Door-to-needle time, symptomatic intracranial hemorrhage, and functional outcome at 3 months were prospectively collected and compared between the groups.
  
  
  RESULTS
  In all, 152 patients were treated with IV thrombolysis; 102 patients were treated with neurologist on-site; whereas 50 patients were treated by internists with telestroke. Fifty-two percent of the telemedical group achieved excellent outcome compared to 43% of the neurologist on-site group (P = .30). Symptomatic intracranial hemorrhage rate (4.0% versus 4.9%, P = 1.0) and mortality (8.3% versus 11.9%, P = .49) were comparable. Using the multiple logistic regression analysis, age, baseline stroke severity, and extent of early ischemic change on brain computed tomography scan, are independent predictors for excellent outcome, whereas the presence of neurologist on-site is not correlated with the outcome.
  
  
  CONCLUSIONS
  Patients treated without neurologist on-site achieved similar outcome. Telephone consultation and teleradiology-guided IV stroke thrombolysis, with the support of on-site internist appeared safe and efficacious.
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong. Electronic address: fwcz01@ha.org.hk.
authors.forename: Wing-Chi
authors.initials: WC
authors.lastname: Fong
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Moamina
authors.initials: M
authors.lastname: Ismail
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Joyce Wai-Ting
authors.initials: JW
authors.lastname: Lo
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Jessica Tsz-Ching
authors.initials: JT
authors.lastname: Li
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Anna Hiu-Yi
authors.initials: AH
authors.lastname: Wong
authors.affiliation: Department of Rehabilitation, Kowloon Hospital, Kowloon, Hong Kong.
authors.forename: Yee-Wah
authors.initials: YW
authors.lastname: Ng
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Phillip Yin-Cheung
authors.initials: PY
authors.lastname: Chan
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Andrew Lung-Tat
authors.initials: AL
authors.lastname: Chan
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Germaine Hiu-Fai
authors.initials: GH
authors.lastname: Chan
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Ka-Wing
authors.initials: KW
authors.lastname: Fong
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Nelson Yuk-Fai
authors.initials: NY
authors.lastname: Cheung
authors.affiliation: Department of Accident and Emergency, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Gordon Chi-Keung
authors.initials: GC
authors.lastname: Wong
authors.affiliation: Department of Accident and Emergency, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Hiu-Fai
authors.initials: HF
authors.lastname: Ho
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Shun-Tim
authors.initials: ST
authors.lastname: Chan
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Vivian Wai-Yan
authors.initials: VW
authors.lastname: Kwok
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Bernard Man-Kam
authors.initials: BM
authors.lastname: Yuen
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: John Hiu-Ming
authors.initials: JH
authors.lastname: Chan
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Patrick Chung-Ki
authors.initials: PC
authors.lastname: Li
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D020521:Stroke / Q000188:drug therapy*; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D019112:Teleradiology / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Hong Kong; Thrombolysis; acute stroke; telemedicine