title: In-Transit Telemedicine Speeds Ischemic Stroke Treatment: Preliminary Results.
abstract: Time to treatment is critically important in ischemic stroke. We compared the efficacy and cost of teleneurology evaluation during patient transport with that of mobile stroke transport units.
  
  
  
  Using cellular-connected telemedicine devices, we assessed 89 presumptive stroke patients in ambulances in transit. Paramedics assisted remote teleneurologists in obtaining a simplified history and examination, then coordinating care with the receiving emergency department. We prospectively assessed door-to-needle and last-known-well-to-needle times for all intravenous alteplase-treated stroke patients brought to our emergency departments by emergency medical services' transport, comparing those with and without in-transit telestroke.
  
  
  
  From January 2015 through March 2016, 111 stroke patients received intravenous alteplase at study emergency departments. Mean door to needle was 13 minutes less with in-transit telestroke (28 versus 41; P=0.02). Although limitations in cellular communication degraded transmission quality, this did not prevent the completion of satisfactory patient evaluations.
  
  
  
  Improvement in time to treat seems comparable with in-transit telestroke and mobile stroke transport units. The low cost/unit makes this approach scalable, potentially providing rapid management of more patients.
authors: From the Department of Neurosciences, Overlook Medical Center, Summit, NJ.
authors: Gary H
authors: GH
authors: Belt
authors: From the Department of Neurosciences, Overlook Medical Center, Summit, NJ.
authors: Robert A
authors: RA
authors: Felberg
authors: From the Department of Neurosciences, Overlook Medical Center, Summit, NJ.
authors: Jane
authors: J
authors: Rubin
authors: From the Department of Neurosciences, Overlook Medical Center, Summit, NJ. john.halperin@atlantichealth.org.
authors: John J
authors: JJ
authors: Halperin
mesh_terms: D061605:Administration, Intravenous; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D004632:Emergency Medical Services; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D017216:Telemedicine / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: emergency medical services; stroke; telemedicine; therapy; time to treatment