In-Ambulance Stroke Consults Reduces Critical Treatment Time for Patients
Prehospital stroke triaging using telestroke consultation in emergency medical services unit (TEMS) is feasible, and could result in shorter door-to-needle time and onset to groin times, according to a study published in the Journal of Stroke and Cerebrovascular Diseases.
Patients with stroke symptoms were evaluated via TEMS using a video call with a stroke provider. After TEMS evaluation, patients were transferred to the nearest stroke centre or thrombectomy capable center depending on stroke severity and symptom onset time.
“We realised that if we could start seeing these patients before they came into the emergency room, we could reduce the time it took for us to treat them,” said Christine Holmstedt, MD, Medical University of South Carolina, Charleston, South Carolina. “We compared time metrics between patients evaluated via TEMS to those via standard telestroke consultation.”
A total of 49 patients were evaluated via TEMS between May 2017 and March 2020. Median age was 66 years, 24 (49%) were females, 15 (30.6%) received intravenous alteplase (tPA) after arrival to a local hospital, and 3 (6.1%) underwent mechanical thrombectomy after bypassing the nearest stroke centre.
Compared with 52 patients who received tPA after standard telestroke consultation, TEMS patients had shorter door-to-needle time (21 min vs 38 min; PP = .04).
“A 15-minute reduction in door-to-treatment time leads to patients with reduced complications from tPA and significant reduction in disability or death,” said Dr. Holmstedt. “They are more likely to be discharged to an acute rehab rather than long-term care, and they have much better functional outcomes.”
This program is especially important in rural areas where patients are spread out geographically. Dr. Holmstedt is currently working to assess the economic impact of the telestroke program and the potential for further expansion.
“These improved outcomes reduce disability and even death for patients seen with acute stroke,” said Dr. Holmstedt. “And they don’t negatively impact the EMT workflow, so we can bring more efficient treatment options to the state’s rural population -- and that’s significant.”
SOURCE: Medical University of South Carolina