Published Online
on July 28, 2005

A more recent version of this article appeared on September 1, 2005

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Submitted on June 9, 2005
Revised on June 9, 2005
Accepted on June 29, 2005

REACH. Clinical Feasibility of a Rural Telestroke Network

David C. Hess MD^*; Samuel Wang MS; William Hamilton MBA, MHA; Sung Lee MD; Carol Pardue RN, MSN; Jennifer L. Waller PhD; Hartmut Gross MD; Fenwick Nichols MD; Christiana Hall MD; and Robert J. Adams MD

From the Departments of Neurology (D.C.H., S.W., W.H., C.P., F.N., C.H., R.J.A.) Biostatistics (J.L.W.), and Emergency Medicine (H.G.), Medical College of Georgia, Augusta; Department of Neurology, Mayo Clinic (S.L.), Rochester, Minn; and Medical College of Georgia Health Incorporated (W.H., C.P.), Augusta.

^* To whom correspondence should be addressed. E-mail: dhess{at}mail.mcg.edu.

Background and Purpose--Development of stroke networks is critical to bringing guideline-driven stroke care to rural, underserved areas.

Methods--A Web-based telestroke tool, REACH, was developed to provide a foundation for a rural stroke network that delivered acute stroke consults 24 hours per day 7 days per week to 8 rural community hospitals in Georgia.

Results--There were 194 acute stroke consults delivered. Thirty patients were treated with tissue plasminogen activator (tPA). The mean National Institutes of Health Stroke Score (NIHSS) was 15.4, and the median NIHSS was 12.5. The mean onset to treatment time (OTT) was 122 minutes. The OTT dropped from 143 minutes in the first 10 patients treated to 111 minutes in last 20 patients. Of the 30 patients treated with tPA, 23% (7) were treated in 90 minutes and 60% (18) were treated within 2 hours. There were no symptomatic intracerebral hemorrhages.

Conclusions--The REACH telestroke system permits the rapid and safe use of tPA in rural community hospitals. Over time, the system became more efficient and OTT decreased.

Key words: tissue plasminogen activator • stroke, acute • stroke, ischemic • telemedicine

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