Web-based program optimizes stroke care in rural areas

Stroke patients in rural communities can be assessed and treated essentially as well by a neurologist via a wireless Internet program as they can in person, according to a new study.

Treatment includes giving the clot-dissolving drug, tPA, when appropriate to help rapidly dissolve stroke-producing clots and minimize brain damage, said Dr. David Hess, chair of the Medical College of Georgia Department of Neurology and a co-author on the study published in the October rapid access issue of Stroke: Journal of the American Heart Association.

tPA was approved by the Food and Drug Administration in 1996 to treat stroke but still is given to less than 5 percent of patients, in part because stroke patients are not evaluated by a neurologist rapidly enough to receive the drug within the first three hours after symptoms begin, Dr. Hess said.

"We literally can be there at the speed of light," said Sam Wang, MCG research scientist and principal author of the Stroke paper that compared in-person exams of 20 stroke patients over a six-month period beginning September 2002 with those via a Web-based system developed by Mr. Wang. During those six months, stroke patients who arrived at MCG Medical Center were seen immediately by the stroke team per standard protocol, then, within the hour, a second neurologist did the same evaluation from his home or office via the REACH system, or Remote Evaluation for Acute Ischemic Stroke.

Neurologists used the standardized National Institutes of Health Stroke Scale Evaluation to assess critical functions such as the patient's ability to think, move and speak. The REACH system enables neurologists to hear and see the patients in real time. Also per standard treatment, patients get a computerized tomography scan, or CT, to help pinpoint the cause and location of a stroke; those CT images also are immediately available for review via the REACH system.

The published report showed no significant

Contact: Toni Baker
Medical College of Georgia

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