Telephone treatment overcomes barriers to optimal stroke care in rural settings

Stroke patients in rural hospitals can get safe, effective treatment with the use of a clot-busting drug when a doctor from a larger hospital is on the telephone guiding the treatment.

These new findings have important implications for overcoming barriers to optimal stroke care in rural settings, according to research to be presented at the American Academy of Neurology's 59th Annual Meeting in Boston, April 28 , May 5, 2007.

"Expert guidance of this treatment over the telephone appears to be safe, practical, and effective," said study author Anand Vaishnav, MD, with the University of Kentucky Medical Center in Lexington, KY.

The study, which is the largest of its kind, evaluated the outcomes of 121 stroke patients who were treated with the drug tissue plasminogen activator (tPA) at a rural community hospital by a stroke neurologist who was on the telephone guiding the treatment. tPA is the only approved treatment for acute ischemic stroke, and must be given within three hours of stroke.

In response to concerns that telephone guidance would delay tPA treatment, the study found it took an average 132 minutes from stroke onset to the beginning of telephone-guided tPA treatment at a rural community hospital. "This is less time than the average 144 minutes it took from stroke onset to tPA treatment in the National Institute of Neurological Disorders and Stroke (NINDS) tPA study, which was a large national study published in 1995," said Vaishnav. "We also had lower rates of bleeding in the brain and death than the original NINDS study."

The study found 2.5 percent of rural patients treated by telephone had symptomatic bleeding in the brain, compared to 6.4 percent in the original NINDS tPA study. In addition, 17 percent of patients in the urban study died, compared to 7.5 percent of the rural patients treated with tPA in this study.

Nearly half of rural patients treated with tPA by telephone went home after an average hospital stay of four days.

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