October 15, 1999

Schwamm

Telemedicine can be used for accurate diagnosis of stroke symptoms

When a stroke cuts off the blood supply to the delicate tissues of the brain, time is one of the most crucial determinants of a patient's survival and overall outcome. In a study in the October issue of Stroke, MGH researchers show that new technologies in telemedicine – the practice of medicine from remote locations over phone lines – can be used to shorten the time required for an accurate diagnosis, especially for patients far from major medical centers.

Lee Schwamm, MD, the MGH neurologist who led the study, notes that, while it is crucial for patients experiencing symptoms of stroke to get to the nearest emergency room right away, many hospitals do not have the specialized knowledge required to correctly and safely apply the latest treatments for acute stroke. If new clot-dissolving drugs are used in the wrong patient or too long after a stroke begins, they can do more harm than good, possibly even killing the patient.

To test whether an established assessment of stroke symptoms could be performed through a telemedicine link as accurately as at the bedside, the study enrolled 20 patients recovering from ischemic strokes – those caused by blockage of a blood vessel – at the MGH or Spaulding Rehabilitation Hospital. Each patient was assessed twice, once by a neurologist at the bedside, the other time by a neurologist communicating with the patient and a bedside nurse via personal computers with integrated video cameras, connected by high-speed data transmission lines. Analysis of the two examinations showed no significant differences in the overall results.

"Now that we have shown that you can accurately and safely make a diagnosis with this kind of link, the next step will be evaluating the technology in real-time diagnostic situations," says Schwamm. "We believe that telemedicine links to tertiary care centers will allow smaller community hospitals – even those in isolated rural areas – to deliver state-of-the-art stroke care."

Co-authors of the study are Saad Shafqut, MD, PhD; Joseph Kvedar, MD; Mary Guanci, RN, MSN; and Yuchiao Chang, PhD, all of the MGH.