Abstract 198: Robotic Telepresence versus Standardly Supervised Stroke Alert Team Assessments
Background: The implementation of telemedicine for stroke has played a vital role in creating universal access to emergency stroke care for patients in both rural and urban communities, regardless of location or hospital resources.
Objective: We evaluated the hypothesis that there is no difference in speed of assessment between vascular neurologist (VN) robotic telepresence and standard VN supervised stroke alert patients in a primary stroke center.
Methods: A retrospective stroke alert database review was used to identify all robotic telepresence and standardly supervised stroke alert patient assessments at Mayo Clinic Hospital Emergency Department from 2009 to 2012. The robotic telepresence cohort was compared to a random sample of standard stroke alert patients, with an equal number of patients selected from each year. The primary outcome measure was the duration of assessment from stroke alert activation to treatment or downgrade.
Results: The sample size was 196 subjects. The mean duration of time from stroke alert activation to initiation of IV thrombolytic treatment or downgrade was 8.6 minutes longer in the robotic telepresence group than in the standard group (P=0.03). There was a higher percentage of patients diagnosed with acute stroke in the robotic stroke alert group than in the standard stroke alert group (77% vs 60%, P=0.01). Controlling for acute stroke, age, and NIHSS did not significantly reduce the time difference between groups. Among the subgroup of acute ischemic stroke patients requiring IV thrombolysis, the mean duration of time from activation to treatment was 18 minutes longer in the robotic group than in the standard group (P=0.01). Safety outcomes including thrombolysis protocol violations (0% vs 1%), post-thrombolysis symptomatic intracranial hemorrhagic complications (3% vs 1%), and death during hospitalization (8% vs 6%) were low in the robotic group and not significantly different from that in the standard group.
Conclusion: Standard VN supervised acute stroke team assessments are swifter than those supervised by robotic telepresence. Safety outcomes of robotic telepresence supervised stroke alerts are excellent, and this modality may be preferred in circumstances when a VN is not immediately available on-site.
Author Disclosures: C.B. O'Carroll: None. J.G. Hentz: None. B.M. Demaerschalk: Other Research Support; Modest; Calgary Scientific. Consultant/Advisory Board; Modest; Cell Trust, REACH. Employment; Significant; Mayo Clinic, Mayo Clinic Center for Connected Care.
- © 2014 by American Heart Association, Inc.