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Technologies Assisting in Remote Consultations for the Diagnosis of Stroke: A Review of the Clinical Evidence

Published on: November 25, 2013
Project Number: RC0499-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Report in Brief

Context
Strokes are the third most common cause of death in Canada. Most strokes are ischemic, caused by a lack of blood flow to the brain, often due to a blood clot.In these cases, rapid diagnosis is needed because it is important to administer thrombolytic (“clot-busting”) drugs within three hours of symptom onset.

Technology
Telemedicine generally refers to two-way videoconferencing or a combination of telephone and image transfer, in which physicians in rural or remote areas communicate with experts at a major centre. Experts provide guidance throughout the clinical consultation and treatment decision-making process. Access to imaging may be through a secure website, Digital Imaging and Communications in Medicine (DICOM) viewer, or email transfer.

Telephone communication is defined as the use of oral communication only. Laboratory results may be communicated verbally, but imaging results are not available to the expert consultant.

Issue
As most stroke experts are located in major centres, patients in rural or remote areas are less likely to receive thrombolytic drugs unless remote physicians can consult the experts in a timely manner. A review of the clinical evidence will help inform decisions about the use of telemedicine.

Methods
A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).

Results
The literature search identified 316 citations, with 1 additional article identified from other sources. After screening the abstracts, 40 were deemed potentially relevant and 17 met the criteria for inclusion in this review — 1 health technology assessment, 1 systematic review, 1 randomized controlled trial, and 14 non-randomized studies.

Key Messages

  • Telemedicine is likely a legitimate option to guide treatment decisions related to ischemic stroke, including the administration of thrombolytic drugs, without compromising patient safety.
  • Telemedicine technologies that allow for image transfer may improve diagnostic accuracy as compared with technologies that do not.
  • Results should be interpreted with caution as most data are from non-randomized or non-blinded studies.

Question

  1. What is the clinical evidence regarding technologies used for remote consultations with neurology specialists in order to optimally diagnose and administer initial treatment for patients presenting with suspected acute stroke or transient ischemic attack?

Key Message

For the diagnosis and treatment of ischemic stroke, it is likely that telemedicine is a legitimate option to guide treatment decisions, including the administration of tPA, at rural and remote hospitals and results in positive outcomes without compromising patient safety. Telemedicine technologies that allow for image transfer tend to perform better than technologies that do not. The majority of the data included in this review is based on non-randomized patients and non-blinded assessors and thus should be interpreted with caution.

Tags

transient ischemic attack, brain ischemia, remote consultation, stroke, telemedicine, emergency medicine, telehealth, ischemic attack, transient, cardiovascular, telestroke, tele-medicine, distance consultation, transient ischaemic attack, transient ischemic attacks, transient ischaemic attacks, TIA, Ischemic Attack, Transient