On Wednesday May 27, 2009 at the 18^th European Stroke Conference, Bart M. Demaerschalk presented the results of the Arizona Department of Health Services sponsored 54 subject “Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) Randomized, Blinded, Prospective Trial in Arizona: The Initial Mayo Clinic Experience (TIME).”

The abstract was published in Cerebrovascular Diseases 2009;27(suppl 6):148. It was feasible to establish a single hub, multi-rural spoke hospital telestroke research network in Arizona.  The feasibility trial was not designed to detect a difference between the two consultative modes, telemedicine and telephone-only.  Overall, the correct stroke treatment decision was established in 87% of the consultations.  Both modalities, telephone (89%-correct) and telemedicine (85%-correct) performed very well.  Overall, intravenous thrombolytics were used in 30% of the consultations and post tPA intracranial hemorrhage was infrequent.  The mean consent to decision durations were not significantly different, 43.7 and 48.6 minutes for telephone and telemedicine respectively.  The learning curve was steep for the hub and spokes of this new telemedicine network, as reflected by the 74% of telemedicine consults which resulted in some technological issues.

At the conclusion of the trial, Mayo Clinic and the Arizona Department of Health Services launched the Stroke Telemedicine for Arizona Rural Residents trial, a prospective 500 subject cohort study investigating the quality and effectiveness of stroke telemedicine consultations in the expanded and still growing state network (Bisbee, Cottonwood, Kingman, Parker, Sedona, and Yuma).

Documentation: Demaerschalk BM, Bobrow BJ for the STRokE DOC Arizona TIME Trialists.  Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) Randomized, Blinded, Prospective Trial in Arizona: The Initial Mayo Clinic Experience (TIME).  Cerebrovascular Diseases 2009; 27(suppl 6):148.  Trial Registry Number: ClinicalTrials.gov Identifier NCT00623350;  Demaerschalk BM, Miley ML, Kiernan TE, et al. Stroke telemedicine.  Mayo Clin Proc 2009; 84(1):53-64;  Capampangan DJ, Wellik KE, Bobrow BJ, et al. Telemedicine versus telephone for remote emergency stroke consultations: a critically appraised topic.  The Neurologist. 2009 May; 15(3):163-166; Demaerschalk BM, Bobrow BJ, Kiernan T, Brazdys K, et al. Stroke Telemedicine for Arizona Rural Residents Trial.  Clinicaltrials.gov identifier NCT00829361.        LINK

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