Feb. 9, 1998 ORLANDO, Feb. 5 -- By using high-tech telecommunications equipment, researchers hope to reduce the time it takes to determine whether an individual having a stroke can be safely given the potentially life saving clot-busting treatment.
The research on this telecommunications approach to stroke evaluation was presented here today at the American Heart Association's 23rd International Joint Conference on Stroke and Cerebral Circulation.
Marian LaMonte, M.D., M.S.N., a neurologist who heads the Brain Attack Team (BAT) at the University of Maryland Medical Center, says that the project, known as Tele-BAT, uses a combination of video, cellular telephone and computer technology. The goal is to reduce the amount of time spent in the emergency room evaluating a person having a stroke.
"Every minute counts now that we have a clot-busting drug (tissue plasminogen activator or TPA). TPA must be given within three hours of the start of a stroke," says LaMonte. "It typically takes approximately 15 minutes to perform the evaluation once patients enter the hospital. With this technology, we can gain valuable information while the patient is in the ambulance en route to the hospital.
"Information provided via Tele-BAT enables the emergency room to be ready to send appropriate patients for a CT scan as soon as they arrive."
The information gathered via this system will help determine whether the patient has indeed had a stroke and when symptoms may have begun. TPA can be safely given within three hours of the initiation of the stroke. Before TPA can be administered, physicians must determine via a CT scan whether the stroke was caused by a clot (ischemic) or bleeding in the brain (hemorrhage). Only ischemic strokes can be treated with TPA.
Although the Tele-BAT process is relatively new -- to date only four patients have been monitored with the system -- LaMonte believes the future holds promise for this system, which is the first in the nation to use this technology for stroke patients.
The basic premise of the technology is that while sitting in her office or at any location with an internet connection, LaMonte can watch as the patient is examined by paramedics in the ambulance en route to the hospital. She can evaluate the patient and give directions to paramedics as they treat the stroke patient.
"With this system, I can see everything going on with the patient in the back of the ambulance," LaMonte says. "I speak with the paramedics as they examine the patient, and we go through the National Institues of Health Stroke Scale together to determine the patient's condition."
The NIH Stroke Scale is a tool to determine severity of stroke and is a valuable means of pre-hospital diagnosis. In addition to seeing the patient, LaMonte receives information on vital signs via the computer during the transport.
"We are in the early stage of this project, which is to evaluate technology as a tool," LaMonte says. "We have been working to refine the system. The next step will be to test it in a clinical trial."
The Brain Attack Team has been in place for a little more than a year and a half and evaluated its first patient with this system in May 1997. During that first run, pictures came across the computer screen every 30 seconds. New images now come across every 10-15 seconds.
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