How Does Telemedicine Help The Door-To-Needle Time In Stroke?

Stroke is unequivocally the fourth leading cause of disability and mortality in the United States. Most ischemic or acute strokes are caused by vessel occlusion due to atheromatous or thromboembolic processes.

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Telestroke as a Component of Stroke Systems of Care

The American Stroke Association published a set of recommendations for the establishment of specialized stroke systems of care in 2005. The proposals shaped a new conceptualizing model for multiple care domains necessary for effective stroke protection, prevention, treatment, and recovery. 

Telestroke was celebrated for its service in various healthcare capacities to support the stroke care system. The emphasis lay on facilitating connections between healthcare providers throughout stroke systems, especially those run in neurologically underserved or rural halkalı escort areas.

Telestroke promotes an organized, standardized, and fitting approach to acute and ischemic stroke care across various healthcare facilities and offers the necessary tools that promote effective treatment. It holds the potential to bridge gaps between the temporal and geographical barriers that can broaden disparities in service access. 

It helps healthcare achieve its primary goal: connecting patients to appropriate healthcare providers in an adequate amount of time to ensure their best interests.

Stroke Care 

Once a patient is diagnosed, the specialist will recommend a treatment. This treatment will typically be a medication that tries to dissolve the blood clot in the patient’s brain. It is possible that the first treatment does not work. Thus, the ability to quickly summon a specialist over telestroke technology is very important, as the specialist can promptly suggest a new course of action for the patient. The fast nature of telestroke can save the patient’s life in these dangerous circumstances.

Even if there are no immediate problems, specialists should be monitoring the patient as they are being treated. This is essential, as small changes in vitals can suggest that the individual is or is not responding to the treatment well. 

Telestroke reduces the need for patients to be transferred to stroke care facilities. Without telestroke, patients in emergency departments that do not have on-call stroke specialists would have no choice but to make their way to a distant care stroke facility. However, with telestroke, patients can ride out their entire stroke treatment in distant hospitals, assuming the hospital has an ICU and imaging services, as they can contact a specialist through telestroke in minutes. 

However, it should be noted that patients who have suffered severe strokes can only be managed through telestroke for a limited time and need to be transferred to a dedicated stroke facility for further treatment. Patients in hospitals without imaging services must also be transported to a stroke facility.  

How does Telemedicine Help the Door-to-Needle Time in Stroke Treatment?

Door-to-Needle (DTN) time in neurology is a concept primarily applicable to managing acute ischemic stroke (AIS). It is the time spanning from a stroke patient’s arrival in emergency care to the initiation of recombinant tissue plasminogen activator (rt-PA) drug therapy.

The door-to-needle time has become exceptionally significant after the spread of the “Time is Brain” concept. This concept, backed by calculations and research, entails that every minute a stroke is left untreated, more than 14 billion synapses and 1.9 neurons die. This supports the cruciality of timely rt-PA treatment in case of acute systemic stroke. 

Additionally, the time taken for treatment has also been shown as a significant determinant of 90-day and 1-year functional health outcomes in AIS. Every 15-minute reduction in the door-to-needle times reduced the odds of risk-adjusted in-hospital mortality by about 5%.

Delayed Door-to-Needle (DTN) Time Mediated by Telestroke 

The door-to-needle time is delayed either because of in-hospital reasons or patient complications. Some common patient-related reasons for delayed DTN time include the following:

• Uncertainty regarding the anticoagulation status.
• Fluctuating neuro deficit.
• Uncertainty regarding symptom time onset.
• Unknown medical history.
• Uncontrolled blood sugar or pressure.

The typical in-hospital reasons for delayed DTN time in stroke may be any of the following:

• Untrained or insufficient emergency room staff in stroke recognition.
• Incorrect triage.
• Delayed transfers from another medical institute or hospital.
• Preoccupied or malfunctioning CT scanners.
• Difficulties in weighing patients.
• Problems with urinary catheters or intravenous drips.
• Delay in obtaining consent from immediate family or guardian.
• Financial issues.

Therefore, telemedicine for stroke helps deal with all such problems by notifying the emergency room of a stroke-equipped hospital about a stroke patient in advance. The single-call activation room run by the stroke team helps prompt triage protocol and notification of the tools needed. With fast brain imaging, specialized stroke toolkit, rapid laboratory testing, pre-mixed rt-PA medication for prospective patients, unhampered access to the rt-PA drug, a team-based medical approach with periodic data and goals review, and quick data feedback after each case, telemedicine deals with all the problems of orthodox medical health administration.

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