Feasibility of prehospital teleconsultation in acute stroke--a pilot study in clinical routine
Inter-hospital teleconsultation improves stroke care. To transfer this concept into the emergency medical service (EMS), the feasibility and effects of prehospital teleconsultation were investigated. Teleconsultation enabling audio communication, real-time video streaming, vital data and still pictu...
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| creator | Bergrath, Sebastian Reich, Arno Rossaint, Rolf Rörtgen, Daniel Gerber, Joachim Fischermann, Harold Beckers, Stefan K Brokmann, Jörg C Schulz, Jörg B Leber, Claas Fitzner, Christina Skorning, Max |
| description | Inter-hospital teleconsultation improves stroke care. To transfer this concept into the emergency medical service (EMS), the feasibility and effects of prehospital teleconsultation were investigated.
Teleconsultation enabling audio communication, real-time video streaming, vital data and still picture transmission was conducted between an ambulance and a teleconsultation center. Pre-notification of the hospital was carried out with a 14-item stroke history checklist via e-mail-to-fax. Beside technical assessments possible influences on prehospital and initial in-hospital time intervals, prehospital diagnostic accuracy and the transfer of stroke specific data were investigated by comparing telemedically assisted prehospital care (telemedicine group) with local regular EMS care (control group). All prehospital stroke patients over a 5-month period were included during weekdays (7.30 a.m.-4.00 p.m.). In 3 of 18 missions partial dropouts of the system occurred; neurological co-evaluation via video transmission was conducted in 12 cases. The stroke checklist was transmitted in 14 cases (78%). Telemedicine group (n = 18) vs. control group (n = 47): Prehospital time intervals were comparable, but in both groups the door to brain imaging times were longer than recommended (median 59.5 vs. 57.5 min, p = 0.6447). The prehospital stroke diagnosis was confirmed in 61% vs. 67%, p = 0.8451. Medians of 14 (IQR 9) vs. 5 (IQR 2) stroke specific items were transferred in written form to the in-hospital setting, p |
| doi_str_mv | 10.1371/journal.pone.0036796 |
| format | Article |
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Teleconsultation enabling audio communication, real-time video streaming, vital data and still picture transmission was conducted between an ambulance and a teleconsultation center. Pre-notification of the hospital was carried out with a 14-item stroke history checklist via e-mail-to-fax. Beside technical assessments possible influences on prehospital and initial in-hospital time intervals, prehospital diagnostic accuracy and the transfer of stroke specific data were investigated by comparing telemedically assisted prehospital care (telemedicine group) with local regular EMS care (control group). All prehospital stroke patients over a 5-month period were included during weekdays (7.30 a.m.-4.00 p.m.). In 3 of 18 missions partial dropouts of the system occurred; neurological co-evaluation via video transmission was conducted in 12 cases. The stroke checklist was transmitted in 14 cases (78%). Telemedicine group (n = 18) vs. control group (n = 47): Prehospital time intervals were comparable, but in both groups the door to brain imaging times were longer than recommended (median 59.5 vs. 57.5 min, p = 0.6447). The prehospital stroke diagnosis was confirmed in 61% vs. 67%, p = 0.8451. Medians of 14 (IQR 9) vs. 5 (IQR 2) stroke specific items were transferred in written form to the in-hospital setting, p<0.0001. In 3 of 10 vs. 5 of 27 patients with cerebral ischemia thrombolytics were administered, p = 0.655.
Teleconsultation was feasible but technical performance and reliability have to be improved. The approach led to better stroke specific information; however, a superiority over regular EMS care was not found and in-hospital time intervals were unacceptably long in both groups. The feasibility of prehospital tele-stroke consultation has future potential to improve emergency care especially when no highly trained personnel are on-scene.
International Standard Randomised Controlled Trial Number Register (ISRCTN) ISRCTN83270177.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0036796</identifier><identifier>PMID: 22629331</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Accuracy ; Aged ; Aged, 80 and over ; Anesthesiology ; Audio data ; Brain ; Brain Ischemia - diagnosis ; Computer Science ; Consultation ; Data transfer (computers) ; Data transmission ; Diagnostic systems ; Emergency medical care ; Emergency medical services ; Emergency Medical Services - methods ; Emergency medicine ; Emergency vehicles ; Facsimile communication ; Feasibility Studies ; Female ; Health services ; Humans ; Influence ; Intervals ; Ischemia ; Male ; Medical care quality ; Medical diagnosis ; Medical referrals ; Medicine ; Middle Aged ; Neuroimaging ; Neurology ; Patients ; Pilot Projects ; Primary care ; Prospective Studies ; Remote Consultation ; Streaming media ; Stroke ; Stroke - diagnosis ; Telemedicine ; Time Factors ; Video communication ; Video transmission</subject><ispartof>PloS one, 2012-05, Vol.7 (5), p.e36796-e36796</ispartof><rights>COPYRIGHT 2012 Public Library of Science</rights><rights>2012 Bergrath et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Bergrath et al. 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-2c0fb875d6ccc4eb069cbd7d48748f5d1c90e8df256dd3951f9be3d2cbc7eb723</citedby><cites>FETCH-LOGICAL-c758t-2c0fb875d6ccc4eb069cbd7d48748f5d1c90e8df256dd3951f9be3d2cbc7eb723</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356340/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356340/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22629331$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bergrath, Sebastian</creatorcontrib><creatorcontrib>Reich, Arno</creatorcontrib><creatorcontrib>Rossaint, Rolf</creatorcontrib><creatorcontrib>Rörtgen, Daniel</creatorcontrib><creatorcontrib>Gerber, Joachim</creatorcontrib><creatorcontrib>Fischermann, Harold</creatorcontrib><creatorcontrib>Beckers, Stefan K</creatorcontrib><creatorcontrib>Brokmann, Jörg C</creatorcontrib><creatorcontrib>Schulz, Jörg B</creatorcontrib><creatorcontrib>Leber, Claas</creatorcontrib><creatorcontrib>Fitzner, Christina</creatorcontrib><creatorcontrib>Skorning, Max</creatorcontrib><title>Feasibility of prehospital teleconsultation in acute stroke--a pilot study in clinical routine</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Inter-hospital teleconsultation improves stroke care. To transfer this concept into the emergency medical service (EMS), the feasibility and effects of prehospital teleconsultation were investigated.
Teleconsultation enabling audio communication, real-time video streaming, vital data and still picture transmission was conducted between an ambulance and a teleconsultation center. Pre-notification of the hospital was carried out with a 14-item stroke history checklist via e-mail-to-fax. Beside technical assessments possible influences on prehospital and initial in-hospital time intervals, prehospital diagnostic accuracy and the transfer of stroke specific data were investigated by comparing telemedically assisted prehospital care (telemedicine group) with local regular EMS care (control group). All prehospital stroke patients over a 5-month period were included during weekdays (7.30 a.m.-4.00 p.m.). In 3 of 18 missions partial dropouts of the system occurred; neurological co-evaluation via video transmission was conducted in 12 cases. The stroke checklist was transmitted in 14 cases (78%). Telemedicine group (n = 18) vs. control group (n = 47): Prehospital time intervals were comparable, but in both groups the door to brain imaging times were longer than recommended (median 59.5 vs. 57.5 min, p = 0.6447). The prehospital stroke diagnosis was confirmed in 61% vs. 67%, p = 0.8451. Medians of 14 (IQR 9) vs. 5 (IQR 2) stroke specific items were transferred in written form to the in-hospital setting, p<0.0001. In 3 of 10 vs. 5 of 27 patients with cerebral ischemia thrombolytics were administered, p = 0.655.
Teleconsultation was feasible but technical performance and reliability have to be improved. The approach led to better stroke specific information; however, a superiority over regular EMS care was not found and in-hospital time intervals were unacceptably long in both groups. The feasibility of prehospital tele-stroke consultation has future potential to improve emergency care especially when no highly trained personnel are on-scene.
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To transfer this concept into the emergency medical service (EMS), the feasibility and effects of prehospital teleconsultation were investigated.
Teleconsultation enabling audio communication, real-time video streaming, vital data and still picture transmission was conducted between an ambulance and a teleconsultation center. Pre-notification of the hospital was carried out with a 14-item stroke history checklist via e-mail-to-fax. Beside technical assessments possible influences on prehospital and initial in-hospital time intervals, prehospital diagnostic accuracy and the transfer of stroke specific data were investigated by comparing telemedically assisted prehospital care (telemedicine group) with local regular EMS care (control group). All prehospital stroke patients over a 5-month period were included during weekdays (7.30 a.m.-4.00 p.m.). In 3 of 18 missions partial dropouts of the system occurred; neurological co-evaluation via video transmission was conducted in 12 cases. The stroke checklist was transmitted in 14 cases (78%). Telemedicine group (n = 18) vs. control group (n = 47): Prehospital time intervals were comparable, but in both groups the door to brain imaging times were longer than recommended (median 59.5 vs. 57.5 min, p = 0.6447). The prehospital stroke diagnosis was confirmed in 61% vs. 67%, p = 0.8451. Medians of 14 (IQR 9) vs. 5 (IQR 2) stroke specific items were transferred in written form to the in-hospital setting, p<0.0001. In 3 of 10 vs. 5 of 27 patients with cerebral ischemia thrombolytics were administered, p = 0.655.
Teleconsultation was feasible but technical performance and reliability have to be improved. The approach led to better stroke specific information; however, a superiority over regular EMS care was not found and in-hospital time intervals were unacceptably long in both groups. The feasibility of prehospital tele-stroke consultation has future potential to improve emergency care especially when no highly trained personnel are on-scene.
International Standard Randomised Controlled Trial Number Register (ISRCTN) ISRCTN83270177.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>22629331</pmid><doi>10.1371/journal.pone.0036796</doi><tpages>e36796</tpages><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_1324607825 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Accuracy Aged Aged, 80 and over Anesthesiology Audio data Brain Brain Ischemia - diagnosis Computer Science Consultation Data transfer (computers) Data transmission Diagnostic systems Emergency medical care Emergency medical services Emergency Medical Services - methods Emergency medicine Emergency vehicles Facsimile communication Feasibility Studies Female Health services Humans Influence Intervals Ischemia Male Medical care quality Medical diagnosis Medical referrals Medicine Middle Aged Neuroimaging Neurology Patients Pilot Projects Primary care Prospective Studies Remote Consultation Streaming media Stroke Stroke - diagnosis Telemedicine Time Factors Video communication Video transmission |
| title | Feasibility of prehospital teleconsultation in acute stroke--a pilot study in clinical routine |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T20%3A51%3A26IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Feasibility%20of%20prehospital%20teleconsultation%20in%20acute%20stroke--a%20pilot%20study%20in%20clinical%20routine&rft.jtitle=PloS%20one&rft.au=Bergrath,%20Sebastian&rft.date=2012-05-18&rft.volume=7&rft.issue=5&rft.spage=e36796&rft.epage=e36796&rft.pages=e36796-e36796&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0036796&rft_dat=%3Cgale_plos_%3EA477067501%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1324607825&rft_id=info:pmid/22629331&rft_galeid=A477067501&rft_doaj_id=oai_doaj_org_article_752ba999fd834f1ba200ab0d4ac64e53&rfr_iscdi=true |