Telestroke: rapid treatment of acute ischemic stroke patients using telemedicine in a Singapore emergency department

Study objective In recent years, telemedicine technology has allowed hospitals without an in-house neurology service access to 24-h neurology consultation from specialized centers, thus paving the way for these hospitals to offer thrombolysis treatment for stroke patients. This article will describe the experience of the study hospital's emergency department (ED) in its use of telemedicine technology to facilitate the rapid treatment of acute ischemic stroke patients.Methods The ED records, in-patient records, and paramedic records of all patients who presented to the study hospital's ED and received thrombolytic treatment for ischemic strokes were retrospectively reviewed.Results From 25 October 2010 to 25 May 2011, using the telemedicine system, a total of 18 patients received thrombolytic treatment for acute ischemic strokes. The overall mean door to needle time was 92.7 min (95% CI 80.0 to 105.5), median 86.0 min. The mean onset of symptoms to needle (OTN) time was 154.9 min (95% CI 136.7 to 173.2), median 148 min. Factors such as presentation during office hours, brought in by ambulances as standby cases, and direct management by senior doctors were associated with shorter door to needle times.Conclusion Telemedicine is an invaluable tool that enables hospitals without 24-h onsite neurology service to offer emergency thrombolysis to eligible stroke patients, who otherwise will not be able to benefit from this therapy. (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.