title: The establishment of a telestroke service using multimodal CT imaging decision assistance: "Turning on the fog lights".
abstract: Telestroke services have been shown to increase stroke therapy access in rural areas. The implementation of advanced CT imaging for patient assessment may improve patient selection and detection of stroke mimics in conjunction with telestroke. We implemented a telestroke service supported by multimodal CT imaging in a rural hospital in Australia. Over 21months we conducted an evaluation of service activation, thrombolysis rates and use of multimodal imaging to assess the feasibility of the service. Rates of symptomatic intracranial haemorrhage and 90-day modified Rankin Score were used as safety outcomes. Fifty-eight patients were assessed using telestroke, of which 41 were regarded to be acute ischemic strokes and 17 to be stroke mimics on clinical grounds. Of the 41 acute stroke patients, 22 patients were deemed eligible for thrombolysis. Using multimodal CT imaging, 8 more patients were excluded from treatment because of lack of treatment target. Multimodal imaging failed to be obtained in one patient. For the 14 treated patients, median door-imaging time was 38min. Median door-treatment time was 91min. A 90-day mRS ⩽2 was achieved in 40% of treated patients. We conclude that a telestroke service using advanced CT imaging for therapy decision assistance can be successfully implemented in regional Australia and can be used to guide acute stroke treatment decision-making and improve access to thrombolytic therapy. Efficiency and safety is comparable to established telestroke services.
authors.affiliation: John Hunter Hospital, Newcastle, NSW, Australia.
authors.forename: Jelle
authors.initials: J
authors.lastname: Demeestere
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Sewell
authors.affiliation: Manning Rural Referral Hospital, Taree, NSW, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rudd
authors.affiliation: John Hunter Hospital, Newcastle, NSW, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Ang
authors.affiliation: Hunter Stroke Service, Hunter New England Health, Newcastle, NSW, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Jordan
authors.affiliation: Manning Rural Referral Hospital, Taree, NSW, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Wills
authors.affiliation: John Hunter Hospital, Newcastle, NSW, Australia.
authors.forename: Carlos
authors.initials: C
authors.lastname: Garcia-Esperon
authors.affiliation: John Hunter Hospital, Newcastle, NSW, Australia.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Miteff
authors.affiliation: John Hunter Hospital, Newcastle, NSW, Australia.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Krishnamurthy
authors.affiliation: John Hunter Hospital, Newcastle, NSW, Australia; University of Newcastle, Callaghan, NSW, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Spratt
authors.affiliation: Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors.forename: Longting
authors.initials: L
authors.lastname: Lin
authors.affiliation: Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bivard
authors.affiliation: John Hunter Hospital, Newcastle, NSW, Australia; University of Newcastle, Callaghan, NSW, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Parsons
authors.affiliation: John Hunter Hospital, Newcastle, NSW, Australia; University of Newcastle, Callaghan, NSW, Australia. Electronic address: christopher.levi@hnehealth.nsw.gov.au.
authors.forename: Christopher
authors.initials: C
authors.lastname: Levi
mesh_terms: D000368:Aged; D001315:Australia; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D000066491:Clinical Decision-Making; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D018579:Patient Selection; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D017216:Telemedicine / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: CT perfusion; Reperfusion therapy; Telemedicine; Telestroke; Thrombectomy; Thrombolysis