TMJ-2017-0006-ver9-Demaerschalk_5P 376..389

The following telestroke guidelines were developed to assist practitioners in providing assessment, diagnosis, management, and/or remote consultative support to patients exhibiting symptoms and signs consistent with an acute stroke syndrome, using telemedicine communication technologies. Although telestroke practices may include the more broad utilization of telemedicine across the entire continuum of stroke care, with some even consulting on all neurologic emergencies, this document focuses on the acute phase of stroke, including both preand in-hospital encounters for cerebrovascular neurological emergencies. These guidelines describe a network of audiovisual communication and computer systems for delivery of telestroke clinical services and include operations, management, administration, and economic recommendations. These interactive encounters link patients with acute ischemic andhemorrhagic stroke syndromeswith acute care facilities with remote and on-site healthcare practitioners providing access to expertise, enhancing clinical practice, and improving quality outcomes and metrics. These guidelines apply specifically to telestroke services and they do not prescribe or recommend overall clinical protocols for stroke patient care. Rather, the focus is on the unique aspects of delivering collaborative bedside and remote care through the telestroke model.

[1]  Hester F. Lingsma,et al.  Letter by Mulder et al Regarding Article, "2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: a Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association". , 2019, Stroke.

[2]  W. Rosamond,et al.  Telemedicine quality and outcomes in stroke , 2017 .

[3]  Kavita Radhakrishnan,et al.  Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association , 2017, Circulation.

[4]  H. Gross,et al.  Emergency Neurological Life Support: Acute Ischemic Stroke , 2012, Neurocritical Care.

[5]  V. Pereira,et al.  Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review , 2016, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[6]  Joanna J McAdam,et al.  ‘It was like he was in the room with us’: patients’ and carers’ perspectives of telemedicine in acute stroke , 2016, Health expectations : an international journal of public participation in health care and health policy.

[7]  Eric E. Smith,et al.  Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association , 2016, Stroke.

[8]  B. Demaerschalk,et al.  A survey and review of telemedicine license portability. , 2015, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[9]  Eli Segal,et al.  Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. , 2015, CJEM.

[10]  M. Ebinger,et al.  Improved Prehospital Triage of Patients With Stroke in a Specialized Stroke Ambulance: Results of the Pre-Hospital Acute Neurological Therapy and Optimization of Medical Care in Stroke Study , 2015, Stroke.

[11]  J. Fiebach,et al.  Mobile computed tomography: prehospital diagnosis and treatment of stroke. , 2015, Current opinion in neurology.

[12]  J. Grotta,et al.  Abstract 52: Establishing the First Mobile Stroke Unit in the United States , 2015, Stroke.

[13]  Mark D. Huffman,et al.  AHA Statistical Update Heart Disease and Stroke Statistics — 2012 Update A Report From the American Heart Association WRITING GROUP MEMBERS , 2010 .

[14]  J. Hentz,et al.  Robotic telepresence versus standardly supervised stroke alert team assessments. , 2015, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[15]  S. Tjoumakaris,et al.  Epidemiology of a large telestroke cohort in the Delaware valley , 2014, Clinical Neurology and Neurosurgery.

[16]  S. Wiedmann,et al.  TeleStroke Units Serving as a Model of Care in Rural Areas: 10-Year Experience of the TeleMedical Project for Integrative Stroke Care , 2014, Stroke.

[17]  Tzu-Ching Wu,et al.  Prehospital Utility of Rapid Stroke Evaluation Using In-Ambulance Telemedicine: A Pilot Feasibility Study , 2014, Stroke.

[18]  J. Majersik,et al.  Abstract 273: Diagnostic Accuracy at a Distance: a Quality of Care Assessment of Telestroke in the Intermountain West , 2014 .

[19]  D. Prefasi,et al.  The effect of telestroke systems among neighboring hospitals: more and better? The Madrid Telestroke Project , 2014, Journal of Neurology.

[20]  W. Hacke,et al.  Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. , 2014, The New England journal of medicine.

[21]  H. Reichmann,et al.  Emergency Transfer of Acute Stroke Patients within the East Saxony Telemedicine Stroke Network: A Descriptive Analysis , 2014, International journal of stroke : official journal of the International Stroke Society.

[22]  E. Warburton,et al.  Thrombolysis Delivery by a Regional Telestroke Network—Experience From the UK National Health Service , 2014, Journal of the American Heart Association.

[23]  J. Kestle Clinical Trials , 2014, World Journal of Surgery.

[24]  Mary G. George,et al.  Factors influencing the decline in stroke mortality: A statement for healthcare professionals from the American Heart Association/American Stroke Association , 2013 .

[25]  J. Switzer,et al.  Cost utility of hub-and-spoke telestroke networks from societal perspective. , 2013, The American journal of managed care.

[26]  S. Tjoumakaris,et al.  Intravenous tissue plasminogen activator administration in community hospitals facilitated by telestroke service. , 2013, Neurosurgery.

[27]  R. Adams,et al.  Telestroke in South Carolina. , 2013, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[28]  Lee Schwamm,et al.  Interactions within stroke systems of care: a policy statement from the American Heart Association/American Stroke Association. , 2013, Stroke.

[29]  Ives Hubloue,et al.  Prehospital Unassisted Assessment of Stroke Severity Using Telemedicine: A Feasibility Study , 2013, Stroke.

[30]  Elizabeth A Krupinski,et al.  ATA practice guidelines for video-based online mental health services. , 2013, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[31]  Alan D. Lopez,et al.  Measuring the global burden of disease. , 2013, The New England journal of medicine.

[32]  D. Hess,et al.  The history and future of telestroke , 2013, Nature Reviews Neurology.

[33]  Julian P Yang,et al.  Targeting telestroke: benchmarking time performance in telestroke consultations. , 2013, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[34]  L. Wechsler,et al.  Impact of telemedicine implementation in thrombolytic use for acute ischemic stroke: the University of Pittsburgh Medical Center telestroke network experience. , 2013, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[35]  M. Frankel,et al.  Remote assessment of stroke using the iPhone 4. , 2013, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[36]  Peter Mariën,et al.  Unassisted Assessment of Stroke Severity Using Telemedicine , 2013, Stroke.

[37]  M. Wintermark,et al.  Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association , 2013, Stroke.

[38]  H. Reichmann,et al.  Reliability of brain CT evaluation by stroke neurologists in telemedicine , 2013, Neurology.

[39]  J. Switzer,et al.  Cost-Effectiveness of Hub-and-Spoke Telestroke Networks for the Management of Acute Ischemic Stroke From the Hospitals’ Perspectives , 2013, Circulation. Cardiovascular quality and outcomes.

[40]  S. Yaghi,et al.  Thrombolysis to stroke mimics in telestroke. , 2013, Journal of telemedicine and telecare.

[41]  C. Molina,et al.  Impact of Telemedicine on Acute Management of Stroke Patients Undergoing Endovascular Procedures , 2012, Cerebrovascular Diseases.

[42]  Qing Wu,et al.  Reliability of Real-Time Video Smartphone for Assessing National Institutes of Health Stroke Scale Scores in Acute Stroke Patients , 2012, Stroke.

[43]  R. Raman,et al.  CT Interpretation in a Telestroke Network: Agreement Among a Spoke Radiologist, Hub Vascular Neurologist, and Hub Neuroradiologist , 2012, Stroke.

[44]  B. Meyer,et al.  Telestroke network fundamentals. , 2012, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[45]  Norman Zerbe,et al.  Telestroke Ambulances in Prehospital Stroke Management: Concept and Pilot Feasibility Study , 2012, Stroke.

[46]  Anand Viswanathan,et al.  The Status of Telestroke in the United States: A Survey of Currently Active Stroke Telemedicine Programs , 2012, Stroke.

[47]  I. Grunwald,et al.  Mobile stroke unit for diagnosis-based triage of persons with suspected stroke , 2012, Neurology.

[48]  R. Raman,et al.  Assessment of long-term outcomes for the STRokE DOC telemedicine trial. , 2012, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[49]  Klaus Fassbender,et al.  Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial , 2012, The Lancet Neurology.

[50]  Rema Raman,et al.  Efficacy of telemedicine for stroke: pooled analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona telestroke trials. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[51]  D. McArthur,et al.  Barriers to telemedicine: survey of current users in acute care units. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[52]  A. Rudd,et al.  Telemedicine versus face-to-face evaluation in the delivery of thrombolysis for acute ischaemic stroke: a single centre experience , 2012, Postgraduate Medical Journal.

[53]  L. Schwamm,et al.  Use of Telemedicine and Other Strategies to Increase the Number of Patients That May Be Treated with Intravenous Thrombolysis , 2012, Current Neurology and Neuroscience Reports.

[54]  R. Nelson,et al.  The cost-effectiveness of telestroke in the treatment of acute ischemic stroke , 2011, Neurology.

[55]  Ron Waksman,et al.  Reliability of Prehospital Real-Time Cellular Video Phone in Assessing the Simplified National Institutes of Health Stroke Scale in Patients With Acute Stroke: A Novel Telemedicine Technology , 2011, Stroke.

[56]  Karin V Nystrom,et al.  We Can Hear ( and See ) You Now : Telestroke Increases tPA Use for Ischemic Stroke , 2011 .

[57]  L. Wechsler,et al.  Protocol adherence and safety of intravenous thrombolysis after telephone consultation with a stroke center. , 2010, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[58]  Rema Raman,et al.  Stroke Team Remote Evaluation Using a Digital Observation Camera in Arizona: The Initial Mayo Clinic Experience Trial , 2010, Stroke.

[59]  J. Switzer,et al.  A Telestroke Network Enhances Recruitment into Acute Stroke Clinical Trials , 2010, Stroke.

[60]  Rebecca A Betensky,et al.  Remote Supervision of IV-tPA for Acute Ischemic Stroke by Telemedicine or Telephone Before Transfer to a Regional Stroke Center Is Feasible and Safe , 2010, Stroke.

[61]  B. Bobrow,et al.  The state of emergency stroke resources and care in rural Arizona: a platform for telemedicine. , 2009, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[62]  J. Switzer,et al.  Telestroke 10 Years Later – ‘Telestroke 2.0’ , 2009, Cerebrovascular Diseases.

[63]  Mary G. George,et al.  Recommendations for the implementation of telemedicine within stroke systems of care: a policy statement from the American Heart Association. , 2009, Stroke.

[64]  Brett C Meyer,et al.  A Review of the Evidence for the Use of Telemedicine Within Stroke Systems of Care: A Scientific Statement From the American Heart Association/American Stroke Association , 2009, Stroke.

[65]  P. Heuschmann,et al.  Long-Term Effects of Specialized Stroke Care With Telemedicine Support in Community Hospitals on Behalf of the Telemedical Project for Integrative Stroke Care (TEMPiS) , 2009, Stroke.

[66]  H. Audebert,et al.  [Acceptance of telemedicine for acute stroke care. The German project TEMPiS]. , 2009, Der Nervenarzt.

[67]  A. Siddiqui,et al.  Acute Ischemic Stroke and Thrombolysis Location: Comparing Telemedicine and Stroke Center Treatment Outcomes , 2009, Hospital practice.

[68]  Mary G. George,et al.  Systems of Care. A Policy Statement From the American Heart Association Recommendations for the Implementation of Telemedicine Within Stroke , 2009 .

[69]  Robert J Adams,et al.  A web-based telestroke system facilitates rapid treatment of acute ischemic stroke patients in rural emergency departments. , 2009, The Journal of emergency medicine.

[70]  T. Ingall,et al.  Stroke telemedicine. , 2009, Mayo Clinic proceedings.

[71]  Ronald G. Thomas,et al.  Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study , 2008, The Lancet Neurology.

[72]  R. Raman,et al.  Reliability of site-independent telemedicine when assessed by telemedicine-naive stroke practitioners. , 2008, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[73]  U. Bogdahn,et al.  Long-term outcome after thrombolysis in telemedical stroke care , 2007, Neurology.

[74]  P. Heuschmann,et al.  Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany , 2006, The Lancet Neurology.

[75]  Christian Kukla,et al.  Comparison of Tissue Plasminogen Activator Administration Management Between Telestroke Network Hospitals and Academic Stroke Centers: The Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany , 2006, Stroke.

[76]  Robert J Adams,et al.  Telestroke: extending stroke expertise into underserved areas , 2006, The Lancet Neurology.

[77]  H. Audebert,et al.  Telestroke: effective networking , 2006, The Lancet Neurology.

[78]  H. Audebert,et al.  [Improvement in stroke care in a non-urban community hospital--quality of procedures before and after participating in a telemedical stroke network]. , 2006, Deutsche medizinische Wochenschrift.

[79]  U. Bogdahn,et al.  Can Telemedicine Contribute to Fulfill WHO Helsingborg Declaration of Specialized Stroke Care? , 2005, Cerebrovascular Diseases.

[80]  Robert J Adams,et al.  REACH: Clinical Feasibility of a Rural Telestroke Network , 2005, Stroke.

[81]  S. Pinkerton AACN standards for establishing and sustaining healthy work environments. , 2005, Nursing economic$.

[82]  Markus Horn,et al.  Telemedicine for Safe and Extended Use of Thrombolysis in Stroke: The Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria , 2005, Stroke.

[83]  Iva Petkovska,et al.  Virtual TeleStroke support for the emergency department evaluation of acute stroke. , 2004, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[84]  Robert J Adams,et al.  Remote Evaluation of Acute Ischemic Stroke in Rural Community Hospitals in Georgia , 2004, Stroke.

[85]  B. Widder,et al.  Teleneurology to Improve Stroke Care in Rural Areas: The Telemedicine in Stroke in Swabia (TESS) Project , 2003, Stroke.

[86]  Mateusz Scibor,et al.  Telemedicine in Emergency Evaluation of Acute Stroke: Interrater Agreement in Remote Video Examination With a Novel Multimedia System , 2003, Stroke.

[87]  David C. Hess,et al.  Remote Evaluation of Acute Ischemic Stroke: Reliability of National Institutes of Health Stroke Scale via Telestroke , 2003, Stroke.

[88]  S. Warach,et al.  Impact of Establishing a Primary Stroke Center at a Community Hospital on the Use of Thrombolytic Therapy: The NINDS Suburban Hospital Stroke Center Experience , 2003, Stroke.

[89]  P. Hu,et al.  Telemedicine for Acute Stroke: Triumphs and Pitfalls , 2003, Stroke.

[90]  P. Langhorne,et al.  Organized Inpatient (Stroke Unit) Care for Stroke , 2014, The Cochrane database of systematic reviews.

[91]  J. Kvedar,et al.  Role for telemedicine in acute stroke. Feasibility and reliability of remote administration of the NIH stroke scale. , 1999, Stroke.

[92]  S. Levine,et al.  "Telestroke" : the application of telemedicine for stroke. , 1999, Stroke.

[93]  Peter Sandercock,et al.  The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischaemic stroke , 1997, The Lancet.