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(Stroke. 2008;39:3427.)
© 2008 American Heart Association, Inc.

Research Letters

Is Mobile Teleconsulting Equivalent to Hospital-Based Telestroke Services?

Heinrich J. Audebert, MD; Sandra Boy, MD; Ralf Jankovits, MD; Philipp Pilz, MD; Jochen Klucken, MD; Nando P. Fehm, MD Johannes Schenkel, MD, MPH

From the Klinik und Poliklinik für Neurologie (H.J.A.), Charité Universitätsmedizin Berlin, Germany; the Department of Neurology (S.B., J.K., N.P.F.), University of Regensburg, Regensburg, Germany; and the Department of Neurology (R.J., P.P., J.S.), Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany.

Correspondence to Heinrich J. Audebert, Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. E-mail heinrich.audebert{at}charite.de

Background and Purpose— Telemedicine is increasingly used to provide acute stroke expertise for hospitals without full-time neurological services. Teleconsulting through mobile laptop computers may offer more flexibility compared with hospital-based services, but concerns about quality and technical reliability remain.

Methods— We conducted a controlled trial, allocating hospital-based or mobile teleconsulting in a shift-by-shift sequence and evaluating technical parameters, acceptability, and impact on immediate clinical decisions. Both types of telemedicine workstations were equipped with DICOM (Digital-Imaging-and-Communications-in-Medicine) viewer and videoconference software. The laptop connected by asymmetrical broadband UMTS (Universal-Mobile-Telecommunication-Systems) technology with a one-way spoke-to-hub video transmission, whereas the hospital-based device used landline symmetrical telecommunication, including a 2-way videoconference.

Results— One hundred twenty-seven hospital-based and 96 mobile teleconsultations were conducted within 2 months without any technical breakdown. The rates per allocated time were similar with 3.8 and 4.0 per day. No significant differences were found for durations of videoconference (mean: 11±3 versus 10±3 minutes, P=0.07), DICOM download (3±3 versus 4±3 minutes, P=0.19), and total duration of teleconsultations (44±19 versus 45±21 minutes, P=0.98). Technical quality of mobile teleconsultations was rated worse on both sides, but this did not affect the ability to make remote clinical decisions like initiating thrombolysis (17% versus 13% of all, P=0.32).

Conclusions— Teleconsultation using a laptop workstation and broadband mobile telecommunication was technically stable and allowed remote clinical decision-making. There remain disadvantages regarding videoconference quality on the hub side and lack of video transmission to the spoke side.

Key Words: mobile telecommunication • stroke • telemedicine