Telestroke in resource-poor developing country model.
BACKGROUND
Telemedicine is a major effort to tackle the uneven availability of facilities for thrombolysis in acute ischemic stroke. We present a telestroke model introduced in a small hilly state of Himachal Pradesh in India.


OBJECTIVE
To provide acute ischemic stroke treatment with tissue plasminogen activator in all district hospitals of Himachal Pradesh with computerized axial tomographic scan facility through Telemedicine.


METHODS
Smartphone-based hub and spoke telestroke model was used with two tertiary care hospitals (with neurologists) as hub and 17 district hospitals (without onsite neurologists) as spokes.


METHODS
The telestroke project was launched in the state of Himachal Pradesh in April 2014. Medical officers in district hospitals (Medicine graduates and Internal Medicine postgraduates) were trained in the treatment of stroke through workshops. Tissue plasminogen activator was made available at all these centers, free of cost through hospital pharmacies. Four neurologists at two tertiary care centers were made available for consultation on phone.


RESULTS
Between June 2014 and May 2015, a total of 26 patients received thrombolysis under the telestroke project at nine district hospitals without onsite presence of a neurologist. Eight patients were females and 18 males. The age of patients ranged from 26 to 80 years. Only 2 patients developed an intracranial bleed following thrombolysis, and both were nonfatal.


CONCLUSIONS
Smartphone-based telestroke services may be a much cheaper alternative to video-conferencing-based telestroke services and are more portable with less technical glitches. To the best of our knowledge, this is the first telestroke model being reported from India. It seems to be the way forward in providing timely treatment in acute ischemic stroke in underserved and resource poor settings.
Department of Neurology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
Sudhir
S
Sharma
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
M V
MV
Padma
Department of Neurology, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India.
Amit
A
Bhardwaj
Department of Neurology, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India.
Ashish
A
Sharma
Department of Neurology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
Nishit
N
Sawal
Department of Radiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
Suresh
S
Thakur
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003906:Developing Countries; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D000068997:Smartphone; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D017216:Telemedicine; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator