Telestroke Assessment on the Move

Thrombolysis as a treatment for ischemic stroke is only indicated within the first 3 to 4.5 hours after onset of symptoms, and is more efficacious the earlier it is given.1,2 Patients must thus seek help, receive a clinical diagnosis, and reach a center of care for imaging and treatment without delay.This is a problem in remote and rural areas, leading to a relative disadvantage for rural dwellers: symptom-to-needle time is nevertheless often too long even for people in major urban centers. In the Scottish Highlands, for example, the total amount of time taken from calling for help, transfer to the nearest diagnostic center, undergoing computed tomography scanning to exclude contraindications to thrombolysis treatment, and then receiving thrombolysis often exceeds the 4.5-hour limit.3 The ambulance service reports that the more rural the patient’s location, the longer their response time is likely to be, reflecting the geography and road network as well as the limited number of vehicles.4 Even among patients with stroke in the Highlands who make it to hospital within the 4.5-hour thrombolysis window, mean times from onset to thrombolysis range from 130 to 210 minutes at the various hospitals audited, and <8% of patients with stroke actually receive the treatment at all.5Scotland has a telestroke program run by the Scottish Center for Telehealth and Telecare, featuring 5 networks around the country.6 They use videoconferencing from the acute hospital site where local physicians can discuss their patients with specialists many miles away. This service has been running successfully since 2008, and thus the idea of using communications technology in stroke assessment is already in place and being successfully used. However, this service is hospital-based, providing support to smaller institutions rather than in prehospital situations.Initial code stroke systems were set up …