title: Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis.
abstract: OBJECTIVE
  To compare the times to evaluation and thrombolytic treatment of patients treated with a telemedicine-enabled mobile stroke treatment unit (MSTU) vs those among patients brought to the emergency department (ED) via a traditional ambulance.
  
  
  METHODS
  We implemented a MSTU with telemedicine at our institution starting July 18, 2014. A vascular neurologist evaluated each patient via telemedicine and a neuroradiologist and vascular neurologist remotely assessed images obtained by the MSTU CT. Data were entered in a prospective registry. The evaluation and treatment of the first 100 MSTU patients (July 18, 2014-November 1, 2014) was compared to a control group of 53 patients brought to the ED via a traditional ambulance in 2014. Times were expressed as medians with their interquartile ranges.
  
  
  RESULTS
  Patient and stroke severity characteristics were similar between 100 MSTU and 53 ED control patients (initial NIH Stroke Scale score 6 vs 7,p= 0.679). There was a significant reduction of median alarm-to-CT scan completion times (33 minutes MSTU vs 56 minutes controls,p< 0.0001), median alarm-to-thrombolysis times (55.5 minutes MSTU vs 94 minutes controls,p< 0.0001), median door-to-thrombolysis times (31.5 minutes MSTU vs 58 minutes controls,p= 0.0012), and symptom-onset-to-thrombolysis times (97 minutes MSTU vs 122.5 minutes controls,p= 0.0485). Sixteen patients evaluated on MSTU received thrombolysis, 25% of whom received it within 60 minutes of symptom onset.
  
  
  CONCLUSIONS
  Compared with the traditional ambulance model, telemedicine-enabled ambulance-based thrombolysis resulted in significantly decreased time to imaging and treatment.
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Ather
authors.initials: A
authors.lastname: Taqui
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Russell
authors.initials: R
authors.lastname: Cerejo
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Itrat
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Farren B S
authors.initials: FB
authors.lastname: Briggs
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Reimer
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Stacey
authors.initials: S
authors.lastname: Winners
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Natalie
authors.initials: N
authors.lastname: Organek
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Buletko
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Lila
authors.initials: L
authors.lastname: Sheikhi
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Sung-Min
authors.initials: SM
authors.lastname: Cho
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Maureen
authors.initials: M
authors.lastname: Buttrick
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Donohue
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Zeshaun
authors.initials: Z
authors.lastname: Khawaja
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Dolora
authors.initials: D
authors.lastname: Wisco
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Frontera
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Russman
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Fredric M
authors.initials: FM
authors.lastname: Hustey
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Damon M
authors.initials: DM
authors.lastname: Kralovic
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Peter
authors.initials: P
authors.lastname: Rasmussen
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH.
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
authors.affiliation: From the Cerebrovascular Center (A.T., R.C., A.I., S.W., M.B., M.M.D., Z.K., D.W., J.A.F., A.N.R., P.R., K.U., M.S.H.), Department of Neurology (N.O., A.B.B., L.S., S.-M.C.), and Critical Care Transport Team (A.P.R., F.M.H., D.M.K.), Cleveland Clinic, OH; and Department of Epidemiology and Biostatistics, School of Medicine (F.B.S.B.), and Frances Payne Bolton School of Nursing (A.P.R.), Case Western Reserve University, Cleveland, OH. hussais4@ccf.org.
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Hussain
mesh_terms: D000368:Aged; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000628:therapy*; D017216:Telemedicine; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D015898:Tomography Scanners, X-Ray Computed