In the TEMPiS TeleStroke system, the probability of a poor outcome (Barthel Index Score <60 or modified Rankin Scale Score >3) was lower in patients networked to telemedicine-enabled consultation.41 Three thousand one hundred and twenty-two patients with ischemic stroke were examined in a nonrandomized, open-intervention study between two supporting academic hospitals and 10 community hospitals (five non-networked hospitals matched to five networked hospitals). Telemedicine intervention was associated in a multivariate analysis with a reduced probability of poor outcome (death, nursing home placement, or severe disability) after 3 months (OR 0.62, 95% CI 0.52-0.74, p < 0.0001). Death or institutionalization alone was not significantly reduced in patients receiving telemedicine intervention (OR 0.88, 95% CI 0.71-1.06 p = 0.18). The impact was primarily of reduced probability of severe disability (14% receiving telemedicine intervention vs. 21% of control patients returned home with severe disability). The rate of symptomatic intracerebral hemorrhage was not significantly increased (7.8% vs. 2.7%, p = 0.14) in a related comparison of the academic stroke centers to these telemedicine-networked community hospitals, even though these networked hospitals controlled blood pressure more strictly and had similar rates of in-hospital mortality (3.5% vs. 4.5%, p = 0.74). This 7.8% rate of symptomatic hemorrhage in networked hospitals nevertheless compares well to the rate found by the NINDS intravenous rt-PA study.1 Investigators in Texas also found that TeleStroke intervention increased the frequency of rt-PA administration from 0.8% to 4.3% at two community hospitals east of Houston, but without an increased incidence of intracerebral hemorrhage.42
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