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Video Consultation Improves Stroke Treatment Decisions

But in remote locations, telemedicine does not lead to higher prescription rates for thrombolytics

TUESDAY, Aug. 5 (HealthDay News) -- In the management of patients in remote locations, use of stroke telemedicine consultations -- real-time, two-way audio and video, and digital imaging and communications -- results in more accurate clinical decision making compared with telephone consultations, according to an article published online Aug. 3 in The Lancet Neurology.

Brett C. Meyer, M.D., of the University of California San Diego School of Medicine Stroke Center, and colleagues randomly assigned 222 patients aged 18 and older who presented with acute stroke symptoms at one of four remote sites in California to either telemedicine or telephone consultation.

The researchers found that correct treatment decisions were more commonly made as a result of telemedicine than telephone consultations (98 percent versus 82 percent). But they also found that there were no significant group differences in the number of patients prescribed thrombolytics (28 percent in the telemedicine group versus 23 percent in the telephone group) or in three-month rates of stroke recurrence or mortality.

"This trial by Meyer and colleagues does not provide definitive evidence for the use of telemedicine," states the author of an accompanying editorial. "Although video conferencing is appealing and seems intuitively effective in remote decision making for thrombolytic treatment in acute stroke, there are many problems to consider, such as incorrect application of recommended procedures by the remote emergency medicine physician and the scarcity of stroke-unit facilities in the remote hospitals, which decreases the likelihood of recovery. Therefore video conferencing-assisted thrombolysis (or 'telethrombolysis') in patients with stroke will remain at evidence level IIb2 (level Ia is the highest grade of evidence in the European Stroke Organization)."

The author of the editorial reports a financial relationship with Boehringer-Ingelheim France.

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