Abstract TP247: Real-time Videomonitoring Markedly Shortens Time Delays For Reperfusion In Acute Stroke
Introduction: Shortening door-to-needle time is one of the major goals of reperfusion therapy for acute stroke. Real-time videomonitoring provides 24/7 expert support and may potentially accelerate actions taken and improve the decision-making in candidates for reperfusion. We aimed to evaluate the impact of real-time videomonitoring on shortening in-hospital time delays for reperfusion therapy and on the quality of care in acute stroke patients.
Methods: We evaluated consecutive patients, candidates for reperfusion who underwent stroke code activation. All were admitted to the ER and emergently evaluated by a Stroke Neurologist either in a designated stroke box with videomonitoring (VM) or in a conventional box without VM (NonVM). In all patients, time delays were prospectively collected in specific worksheets. Real-time VM was conducted by experienced stroke researchers who interacted and encouraged speediness of the evaluation process as well as timed and stored images at pre-specified time-points.
Results: A total of 100 patients were evaluated. 50 on each arm. There were no significant differences between groups in baseline characteristics: Age (VM 70.7 ±16 vs. 71.1±12 in NonVM patients), gender (52% and 50% of men), median time from symptoms onset to admission (76 vs. 73min) and baseline stroke severity NIHSS score (6 vs. 7). In the VM group the median time for blood sampling was 5minutes, and duration of TCD exam 7minutes. Overall median time in box was significantly shorter in VM 13±9min compared to NonVM 20±12 min, p=0.045. VM significantly reduces the time to fist neurological evaluation <5min (VM 98% vs. NonVM 88%), p=0.038. Door-to-CT time was <25minutes in VM (50%) compared to NonVM (42%), p=0,052. 48% of VM and 44% of NonVM patients received reperfusion therapy. The goal of door-to-needle <40min was achieved in 77.8% of VM compared to only 52% of NonVM patients (p=0.034).
Conclusion: Real-time VM markedly reduces in-hospital delays for reperfusion therapy by shortening time to neurological evaluation, time to CT, and door-to-needle times. Larger studies are needed to evaluate the yield and impact of real-time VM on stroke outcome.
- © 2012 by American Heart Association, Inc.