Telemedicine-assisted treatment of patients with intracerebral hemorrhage.

Object. Telemedicine provides a new approach to improve stroke care in community settings, delivering acute
stroke expertise to hospitals in rural areas. Given the controversies in many aspects of the treatment of intracerebral
hemorrhage (ICH) and the lack of guidelines, a prompt neurosurgical second opinion may facilitate the treatment of
patients with ICH. Here, the authors’ 8-year experience with the use of telemedicine in the management of ICH is
reported.
Methods. The medical records of patients with ICH treated through a telemedicine system in the district of
Messina, Italy, between June 2003 and June 2011 were retrospectively reviewed. Neuroradiological and clinical
data for patients were transmitted through a high-technology “hub-and-spoke” telemedicine network. Neurosurgical
teleconsulting (at the hub) was available for 7 peripheral hospitals (spokes) serving about 700,000 people. The authors analyzed 1) the time between peripheral hospital admission and the specialized second opinion consultation, 2)
primary and secondary transfers to the authors’ neurosurgery department, and 3) the treatments (surgical or medical)
of patients transferred to the hub.
Results. The telemedicine network was used to treat more than 2800 patients, 733 with ICH. A neurosurgical
consultation was provided in 38 minutes versus 160 minutes for a consultation without telemedicine. One hundred
seventy-six (24%) of 733 patients were primarily transferred to the hub. Ninety-five patients (13%) underwent surgical treatment. The remaining 81 patients (11%) underwent neurointensive care. Eight (1.4%) of 557 patients treated
at the spokes needed a secondary transfer for surgical treatment because of a worsening clinical condition and/or CT
findings. Considering secondary and inappropriate transfers, the interpretation of data was correct in 96.5% of cases.
Conclusions. Telemedicine allowed rapid visualization of neuroradiological and clinical data, providing neurosurgical expertise to community hospitals on demand and within minutes. It allowed the treatment of patients at
peripheral hospitals and optimized resources. A small percentage of patients treated at the peripheral hospitals had
secondary deterioration. Telemedicine allowed fast patient transfer when necessary and provided improved accuracy
in patient care