Interactive, two-way audio and video communication in real time emerges as a new method for the fast evaluation of stroke patients in small community hospitals in order to determine the best possible therapy. At the Wayne State University School of Medicine in Michigan, Professor Steven R. Levine is involved in the Telestroke concept, a programme that studies the use of videoconferencing to interconnect stroke specialists and physicians at remote emergency units. At the University of Maryland School of Medicine, Dr. Marian P. LaMonte, an assistant professor of neurology, has already set up a telemedicine system to offer aid to stroke victims in the rural region of Southern Maryland.
Physicians have no time to waste if a stroke occurs to prevent the patient from severe disability. Within three hours after the stroke symptoms begin, Tissue Plasminogen Activator (TPA), a clot-dissolving drug, should be administered to patients having strokes which are caused by blocked blood vessels leading to the brain. In turn, victims of hemorrhagic strokes, due to a leaking or burst blood vessel in the brain, only can be saved with instant surgery. Doctors in rural areas are somewhat reluctant to give clot-busting drugs to stroke patients for fear they might cause excessive or fatal bleeding. The assistance of a stroke expert by means of videoconferencing could lessen the local physician's uncertainty.
The Telestroke concept, as envisioned by Dr. Levine, has to operate using a two-way videoconferencing system via desktop computers to link the stroke specialist with the emergency room staff in a small hospital. Together, they work as a team to evaluate the patient, administer a stroke-assessment test, read the patient's imaging scans, diagnose the type of stroke, administer the appropriate medication, and perform surgery, if necessary. The expert is able to also interact with the patient and his family. Dr. Levine is aiming to test the Telestroke programme in several clinical trials to assess the benefits and therefore will launch a pilot study in the course of 1999. On the other hand, the University of Iowa has plans to integrate Telestroke in a comprehensive telemedicine project, sponsored by the National Library of Medicine.
The Maryland project, initiated by the Brain Attack Team at the University's Medical Center, is already up and running through the combined efforts of the University of Maryland, St. Mary's Hospital and co-sponsor Bell Atlantic. The two locations at St. Mary's in Leonardtown and at the Medical Center in Baltimore are equipped with video cameras, television monitors and specific computer software. The audio and video data are transmitted through three high-speed digital telephone lines via the use of ISDN or Integrated Services Digital Network. The superior image quality allows the stroke expert to see the dilation of the patient's pupils. Doctors can relay lab data, such as vital signs, blood type, and the status of a patient's blood clot as well as transmit a patient's CT scan for remote consultation.
Teleconsultation for stroke victims first of all saves more lives but also huge sums of money. In the United States, stroke forms the third leading cause of death, striking over 600.000 citizens annually, and even the second among women. The treatment and rehabilitation costs amount to an estimated $41 billion, whereas adult disability is predominantly due to stroke. In Michigan alone, therapy rises to over $1 billion each year whereas Southern Maryland counts the state's second-highest death rate from stroke. In the fight against stroke, the University of Maryland wants to build a statewide network which connects rural community hospitals with a vast array of experts. At present, a mobile telemedicine service already evaluates the stroke victims on moving ambulances before they get to the hospital.
In the long run, both the Michigan and Maryland experience will be extended to brain injuries, shock trauma, emergency care, cancer as well as paediatric patients. The Maryland network will also serve as a tool for ongoing medical training and education for physicians and other health care providers in the rural communities.