This Article Full Text Full Text (PDF) All Versions of this Article: 35/7/1763    most recent 01.STR.0000131858.63829.6ev1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, S. Articles by Hess, D. C. Search for Related Content PubMed PubMed Citation Articles by Wang, S. Articles by Hess, D. C. Related Collections Acute Cerebral Infarction Thrombolysis

(Stroke. 2004;35:1763.)
© 2004 American Heart Association, Inc.

Original Contributions

Remote Evaluation of Acute Ischemic Stroke in Rural Community Hospitals in Georgia

Sam Wang, MS; Hartmut Gross, MD; Sung Bae Lee, MD; Carol Pardue, BS, MSN; Jennifer Waller, PhD; Fenwick T. Nichols, III, MD; Robert J. Adams, MD David C. Hess, MD

From the Department of Neurology, Medical College of Georgia, Augusta, Ga.

Correspondence to Dr Sam Wang, Department of Neurology, Medical College of Georgia, 1429 Harper Street, Building HF-1154, Augusta, GA 30912. E-mail swang{at}mail.mcg.edu

Background and Purpose— Despite Food and Drug Administration approval of tissue-type plasminogen activator (tPA) for stroke, obstacles in the US health care system prevent widespread use. The Remote Evaluation for Acute Ischemic Stroke (REACH) program was developed to address these obstacles in rural settings. We have previously shown the reliability of the REACH system in performing a valid National Institutes of Health Stroke Scale (NIHSS) evaluation at the Medical College of Georgia (MCG). We now report on the performance of the system since its deployment in 5 rural hospitals in east Georgia.

Methods— The rural emergency department (ED) staff can activate a Code REACH protocol 24 hours per day, 7 days per week by calling the Emergency Communications Center (ECC, an in-house dispatch center) at MCG, who pages the on-call consultant. The consultant calls back the ECC and is connected to the waiting ED. Simultaneously, using any broadband-connected workstation, the consultant logs in to the REACH system, allowing performance of an NIHSS evaluation, review of the computerized tomography (CT) images transmitted by the local radiology staff, and then the consultant can speak to the patient and family to verify time of onset.

Results— The REACH system has evaluated 75 patients from March 2003 to April 2004, and 12 have received tPA, all without intracranial hemorrhage complications. NIHSS scores ranged from 0 to 30, with a mean of 14.3 (SD=8.7, median 11.5). The mean onset to door time was 70.9 minutes (SD=70.8, median 50), the mean door to consult time was 45.1 minutes (SD=39.8, median 34), and the mean door to NIHSS completion was 62.9 minutes (SD=50.8, median 51). The mean onset to needle time was 135.33 minutes (SD=51.45, median 134.5).

Conclusion— The REACH system enables remote stroke physicians to direct the local ED staff to administer tPA in rural settings where thrombolytics were not previously used. REACH may be used as a rapid consult tool to provide the same quality of stroke care to patients in rural hospitals as is given in tertiary stroke centers. This supports our endeavor to bring stroke expertise to rural community hospitals.

Key Words: stroke assessment • stroke, ischemic • telemedicine

This article has been cited by other articles:

				R. L Kane, C. T Bever, M. Ehrmantraut, A. Forte, W. J Culpepper, and M. T Wallin Teleneurology in patients with multiple sclerosis: EDSS ratings derived remotely and from hands-on examination J Telemed Telecare, June 1, 2008; 14(4): 190 - 194. [Abstract] [Full Text] [PDF]

				J. E. Acker III, A. M. Pancioli, T. J. Crocco, M. K. Eckstein, E. C. Jauch, H. Larrabee, N. M. Meltzer, W. C. Mergendahl, J. W. Munn, S. M. Prentiss, et al. Implementation Strategies for Emergency Medical Services Within Stroke Systems of Care: A Policy Statement From the American Heart Association/ American Stroke Association Expert Panel on Emergency Medical Services Systems and the Stroke Council Stroke, November 1, 2007; 38(11): 3097 - 3115. [Full Text] [PDF]

				S. Schwab, B. Vatankhah, C. Kukla, M. Hauchwitz, U. Bogdahn, A. Furst, H. J. Audebert, M. Horn, and On behalf of the TEMPiS Group Long-term outcome after thrombolysis in telemedical stroke care Neurology, August 28, 2007; 69(9): 898 - 903. [Abstract] [Full Text] [PDF]

				E. C. Leira, J. K. Pary, P. H. Davis, K. J. Grimsman, and H. P. Adams Jr Slow Progressive Acceptance of Intravenous Thrombolysis for Patients With Stroke by Rural Primary Care Physicians Arch Neurol, April 1, 2007; 64(4): 518 - 521. [Abstract] [Full Text] [PDF]

				D. C. Hess, S. Wang, W. Hamilton, S. Lee, C. Pardue, J. L. Waller, H. Gross, F. Nichols, C. Hall, and R. J. Adams REACH: Clinical Feasibility of a Rural Telestroke Network Stroke, September 1, 2005; 36(9): 2018 - 2020. [Abstract] [Full Text] [PDF]

				Can Telemedicine Make Thrombolysis Standard for Rural Stroke Treatment? Journal Watch Neurology, November 5, 2004; 2004(1105): 2 - 2. [Full Text]