Speedy Stroke Treatment via Internet

A new telemedicine examination based on the Internet enables stroke patients to receive the same rapid treatment in remote or rural communities that is provided in bigger hospitals with stroke teams.

A study of 194 stroke patients in eight rural hospitals in Georgia (USA) seen via the Internet system, called REACH (remote evaluation for acute ischemic stroke), showed that 60% of the 30 patients treated with clot-dissolving tissue plasminogen activator (tPA) received the treatment in less than two hours, while 23% were treated in 90 minutes or less. The study showed no difference in the results of patients seen via REACH and in person. The findings were reported in the September 2005 issue of Stroke.

"I think it argues that the REACH system doesn't just treat patients who never got treated before, but it treats them fast,” said lead author Dr. David Hess, chair of the department of neurology at the Medical College of Georgia (MCG, Augusta, USA).

In the United States alone, 80% of the 700,000 strokes that occur annually are clot-based but only a small percentage of patients are treated with tPA because of delays in seeking treatment and the limited availability of stroke teams to assess and treat them when they do. According to Dr. Hess, although there is a three-hour window for treating stroke patients, treatment in less than two hours or, better still, under 90 minutes improves outcomes. "We actually look upon it as though we have a two-hour stroke window now.”

The REACH system was developed by Sam Wang, a research scientist now a second-year medical student at MCG. The system includes a portable station at the remote site, which can be accessed by a stroke specialist from any computer with Internet access. Staffers at the remote hospital reach the on-call member of the MCG's stroke team by calling a 24-hour emergency communications center. MCG is now working with the American Heart Association (AHA) to develop a statewide stroke plan. The AHA wants every U.S. state to have such a plan.




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Medical College of Georgia