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Internet Stroke Exam Speeds Treatment in Rural
Georgia
By Toni Baker
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Photo by Phil Jones |
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Sept. 13, 2005 - An Internet-based examination
system enables stroke patients to be treated as rapidly in rural
communities as they are in bigger hospitals with stroke teams,
researchers have found.
A study of 194 stroke patients in eight rural
Georgia hospitals seen via the REACH system by stroke team members at an
academic medical center showed most patients got clot-dissolving tPA in
less than two hours, says Dr. David Hess, chair of the Medical College
of Georgia Department of Neurology and lead author on the study
published in the September issue of Stroke.
The clot buster, tissue plasminogen activator,
which received Food and Drug Administration approval in 1996 as the
first and still the only approved stroke treatment, must be given within
three hours of symptoms.
While we have a three-hour window, the evidence
suggests that if you treat patients with tPA in under two hours or, even
better, under 90 minutes, you improve your outcome, says Dr. Hess. We
actually look upon it as though we have a two-hour stroke window now.
Sixty percent of the 30 patients treated with tPA
between March 2003-February 2004 got the drug in under two hours; 23
percent were treated in 90 minutes or less. I think it argues that the
REACH system doesnt just treat patients who never got treated before,
but it treats them fast, says Dr. Hess.
Eighty percent of the 700,000 strokes that occur
annually in the United States are clot-based but only a small percentage
of patients get tPA because of delays in patients seeking treatment and
limited availability of stroke teams to assess and treat them when they
do, Dr. Hess says.
Sam Wang, a research scientist who is now a
second-year medical student at MCG, developed the REACH Remote
Evalution for Acute Ischemic Stroke system that has a portable station
at the remote site and can be accessed by a stroke specialist from any
computer with Internet access. Staff at the remote hospital reach the
on-call member of MCGs stroke team by calling a 24-hour Emergency
Communications Center.
A study published in the October 2003 rapid-access
issue of Stroke showed essentially no difference in the results of
patients seen via REACH and in person.
The newer study showed none of the treated patients
had symptomatic brain hemorrhages, a potential side effect of tPA. It
also indicates use of the system became more efficient over time,
dropping onset to treatment time from 143 minutes in the first 10
patients to 111 minutes in the last 20.
Rural hospitals tend to have quieter emergency rooms than their big-city
counterparts so patients typically are seen rapidly and have little or
no wait for a confirmatory computerized tomography scan, Dr. Hess says.
There are some concerns that telemedicine would be too slow, there
would be too many delays. This shows you can treat quickly. If this
works in a very difficult environment with small hospitals, its a model
of what can be done in the state of Georgia or any state, says Dr.
Hess.
In fact, state lines are the primary boundary for
REACH because physicians have to be licensed to practice in the state
where the patient is being seen, he says. National stroke care criteria
could eliminate that problem, he adds.
MCG is working with the Southeast Affiliate of the
American Heart Association to help develop a statewide stroke plan for
Georgia. The national association wants every state to have such a plan,
Dr. Hess says.
The Georgia Research Alliance helped MCG develop a
business plan that could make REACH available to other states by
detailing the installation, training and relationship building required
for a successful program, he says.
Stroke care became more lucrative for hospitals
recently when Medicare tripled their reimbursement for stroke care, but
physicians are not paid to take call for such after-hour services, so
staffing can be a problem, Dr. Hess says.
Georgia hospitals participating in the existing
network include McDuffie Regional Medical Center, Thomson; Emanuel
County Medical Center, Swainsboro; Washington County Regional Medical
Center, Sandersville; Wills Memorial Hospital, Washington; Jenkins
County Hospital, Millen; Jefferson Hospital, Louisville; Elbert County
Hospital, Elberton; and Morgan County Hospital, Madison.
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