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Table of Contents
Vol. 27, Suppl. 4, 2009
Issue release date: June 2009

Telestroke: Scientific Results

Audebert H.J. · Schwamm L.
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Telestroke is the application of telemedicine in stroke care. Hence, teleconsultation means the performance of consultation by a remotely located expert through the use of high-quality videoconferencing. Remote evaluation of stroke patients via telemedicine is increasingly utilized, particularly in neurologically underserved areas. It is usually based on video examination and evaluations of brain scans via teleradiology. Scientific analyses have demonstrated the reliability of neurological assessments via videoconference. Teleradiology using electronically transmitted original imaging data is potentially equivalent to onsite assessment. Telemedicine consultation including video examination and teleradiology improves accuracy of acute stroke treatment decisions compared to telephone-based consultation. Telemedicine is already frequently used to extend the benefits of intravenous thrombolysis to patients in nonspecialized hospitals. Beyond thrombolysis, telemedicine can be used for immediate decision making in acute stroke, e.g. for triage of patients who might benefit from interventional treatments not available at the referring hospital. However, improved clinical outcomes of stroke patients have only been investigated and shown when telemedicine was combined with the Stroke Unit concept based on specialized stroke wards and organized stroke care. More scientific evaluation is needed in the fields of cost effectiveness, quality management and implementation of further technological innovations. There are still insufficient data about the use of telemedicine in stroke prevention, rehabilitation and post-stroke care.

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  1. Langhorne P: Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 2007; CD000197.
  2. Hacke W, Donnan G, Fieschi C, et al: Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004;363:768–774.
  3. Sandercock P, Gubitz G, Foley P, et al: Antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev 2003;2:CD000029.
  4. Vahedi K, Hofmeijer J, Juettler E, et al: Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007;6:215–222.
  5. Leys D, Ringelstein EB, Kaste M, et al: Facilities available in European hospitals treating stroke patients. Stroke 2007;38:2985–2991.
  6. Levine SR, Gorman M: ‘Telestroke’: the application of telemedicine for stroke. Stroke 1999;30:464–469.
  7. Shafqat S, Kvedar JC, Guanci MM, et al: Role for telemedicine in acute stroke: feasibility and reliability of remote administration of the NIH stroke scale. Stroke 1999;30:2141–2145.
  8. Meyer BC, Lyden PD, Al Khoury L, et al: Prospective reliability of the STRokE DOC wireless/site independent telemedicine system. Neurology 2005;64:1058–1060.
  9. Wang S, Lee SB, Pardue C, et al: Remote evaluation of acute ischemic stroke: reliability of National Institutes of Health Stroke Scale via telestroke. Stroke 2003;34:e188–e191.
  10. Handschu R, Littmann R, Reulbach U, et al: Telemedicine in emergency evaluation of acute stroke: interrater agreement in remote video examination with a novel multimedia system. Stroke 2003;34:2842–2846.
  11. Brott T, Adams HP Jr, Olinger CP, et al: Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864–870.
  12. Goldstein LB, Bertels C, Davis JN: Interrater reliability of the NIH stroke scale. Arch Neurol 1989;46:660–662.
  13. Johnston KC, Worrall BB: Teleradiology Assessment of Computerized Tomographs Online Reliability Study (TRACTORS) for acute stroke evaluation. Telemed J E Health 2003;9:227–233.
  14. Llanes JN, Kidwell CS, Starkman S, et al: The Los Angeles Motor Scale (LAMS): a new measure to characterize stroke severity in the field. Prehosp Emerg Care 2004;8:46–50.
  15. Kidwell CS, Starkman S, Eckstein M, et al: Identifying stroke in the field: prospective validation of the Los Angeles Prehospital Stroke Screen (LAPSS). Stroke 2000;31:71–76.
  16. Bray JE, Martin J, Cooper G, et al: Paramedic identification of stroke: community validation of the Melbourne Ambulance Stroke Screen. Cerebrovasc Dis 2005;20:28–33.
  17. Liferidge AT, Brice JH, Overby BA, et al: Ability of laypersons to use the Cincinnati Prehospital Stroke Scale. Prehosp Emerg Care 2004;8:384–387.
  18. Ziegler V, Rashid A, Muller-Gorchs M, et al: Mobile computing systems in preclinical care of stroke: results of the Stroke Angel initiative within the BMBF project PerCoMed (in German). Anaesthesist 2008;57:677–685.
  19. LaMonte MP, Cullen J, Gagliano DM, et al: TeleBAT: mobile telemedicine for the Brain Attack Team. J Stroke Cerebrovasc Dis 2000;9:128–135.
  20. Audebert HJ, Wimmer ML, Hahn R, et al: Can telemedicine contribute to fulfill WHO Helsingborg Declaration of specialized stroke care? Cerebrovasc Dis 2005;20:362–369.
  21. Muller R, Pfefferkorn T, Vatankhah B, et al: Admission facility is associated with outcome of basilar artery occlusion. Stroke 2007;38:1380–1383.
  22. Pfefferkorn T, Mayer TE, Opherk C, et al: Staged escalation therapy in acute basilar artery occlusion: intravenous thrombolysis and on-demand consecutive endovascular mechanical thrombectomy: preliminary experience in 16 patients. Stroke 2008;39:1496–1500.
  23. Vatankhah B, Schenkel J, Furst A, et al: Telemedically provided stroke expertise beyond normal working hours. The Telemedical Project for Integrative Stroke Care. Cerebrovasc Dis 2008;25:332–337.
  24. Audebert HJ, Schenkel J, Heuschmann PU, et al: Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany. Lancet Neurol 2006;5:742–748.
  25. Audebert HJ, Schultes K, Tietz V, et al: Long-term effects of specialized stroke care with telemedicine support in community hospitals on behalf of the Telemedical Project for Integrative Stroke Care (TEMPiS). Stroke 2009;40:902–908.
  26. Müller H, Nimmrichter B, Schenkel J, et al: Verbesserung der Schlaganfall-Behandlung in einem regionalen Versorgungskrankenhaus: Prozessqualität vor und nach Einbindung in ein telemedizinisch unterstütztes Schlaganfall-Netzwerk. Dtsch Med Wochenschr 2006;131:1309–1314.
  27. Audebert HJ, Boy S, Jankovits R, et al: Is mobile teleconsulting equivalent to hospital based telestroke services? Stroke 2008;39:3427–3430.
  28. Piron L, Tonin P, Atzori AM, et al: Virtual environment system for motor tele-rehabilitation. Stud Health Technol Inform 2002;85:355–361.

    External Resources

  29. Adamovich SV, Merians AS, Boian R, et al: A virtual reality based exercise system for hand rehabilitation post-stroke: transfer to function. Conf Proc IEEE Eng Med Biol Soc 2004;7:4936–4939.
  30. Palsbo SE: Equivalence of functional communication assessment in speech pathology using videoconferencing. J Telemed Telecare 2007;13:40–43.
  31. Green BB, Cook AJ, Ralston JD, et al: Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA 2008;299:2857–2867.
  32. Cleland JG, Louis AA, Rigby AS, et al: Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. J Am Coll Cardiol 2005;45:1654–1664.
  33. Vontetsianos T, Giovas P, Katsaras T, et al: Telemedicine-assisted home support for patients with advanced chronic obstructive pulmonary disease: preliminary results after nine-month follow-up. J Telemed Telecare 2005;11(suppl 1):86–88.

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