TY - JOUR
T1 - Is mobile teleconsulting equivalent to hospital-based telestroke services?
AU - Audebert, Heinrich J.
AU - Boy, Sandra
AU - Jankovits, Ralf
AU - Pilz, Philipp
AU - Klucken, Jochen
AU - Fehm, Nando P.
AU - Schenkel, Johannes
PY - 2008/12/1
Y1 - 2008/12/1
N2 - Background and Purpose: Telemedicine is increasingly used to provide acute stroke expertise for hospitals without full-time neurological services. Teleconsulting through mobile laptop computers may offer more flexibility compared with hospital-based services, but concerns about quality and technical reliability remain. Methods: We conducted a controlled trial, allocating hospital-based or mobile teleconsulting in a shift-by-shift sequence and evaluating technical parameters, acceptability, and impact on immediate clinical decisions. Both types of telemedicine workstations were equipped with DICOM (Digital-Imaging-and-Communications-in-Medicine) viewer and videoconference software. The laptop connected by asymmetrical broadband UMTS (Universal-Mobile-Telecommunication-Systems) technology with a one-way spoke-to-hub video transmission, whereas the hospital-based device used landline symmetrical telecommunication, including a 2-way videoconference. Results: One hundred twenty-seven hospital-based and 96 mobile teleconsultations were conducted within 2 months without any technical breakdown. The rates per allocated time were similar with 3.8 and 4.0 per day. No significant differences were found for durations of videoconference (mean: 11±3 versus 10±3 minutes, P≤0.07), DICOM download (3±3 versus 4±3 minutes, P≤0.19), and total duration of teleconsultations (44±19 versus 45±21 minutes, P≤0.98). Technical quality of mobile teleconsultations was rated worse on both sides, but this did not affect the ability to make remote clinical decisions like initiating thrombolysis (17% versus 13% of all, P≤0.32). Conclusions: Teleconsultation using a laptop workstation and broadband mobile telecommunication was technically stable and allowed remote clinical decision-making. There remain disadvantages regarding videoconference quality on the hub side and lack of video transmission to the spoke side.
AB - Background and Purpose: Telemedicine is increasingly used to provide acute stroke expertise for hospitals without full-time neurological services. Teleconsulting through mobile laptop computers may offer more flexibility compared with hospital-based services, but concerns about quality and technical reliability remain. Methods: We conducted a controlled trial, allocating hospital-based or mobile teleconsulting in a shift-by-shift sequence and evaluating technical parameters, acceptability, and impact on immediate clinical decisions. Both types of telemedicine workstations were equipped with DICOM (Digital-Imaging-and-Communications-in-Medicine) viewer and videoconference software. The laptop connected by asymmetrical broadband UMTS (Universal-Mobile-Telecommunication-Systems) technology with a one-way spoke-to-hub video transmission, whereas the hospital-based device used landline symmetrical telecommunication, including a 2-way videoconference. Results: One hundred twenty-seven hospital-based and 96 mobile teleconsultations were conducted within 2 months without any technical breakdown. The rates per allocated time were similar with 3.8 and 4.0 per day. No significant differences were found for durations of videoconference (mean: 11±3 versus 10±3 minutes, P≤0.07), DICOM download (3±3 versus 4±3 minutes, P≤0.19), and total duration of teleconsultations (44±19 versus 45±21 minutes, P≤0.98). Technical quality of mobile teleconsultations was rated worse on both sides, but this did not affect the ability to make remote clinical decisions like initiating thrombolysis (17% versus 13% of all, P≤0.32). Conclusions: Teleconsultation using a laptop workstation and broadband mobile telecommunication was technically stable and allowed remote clinical decision-making. There remain disadvantages regarding videoconference quality on the hub side and lack of video transmission to the spoke side.
KW - Mobile telecommunication
KW - Stroke
KW - Telemedicine
UR - http://www.scopus.com/inward/record.url?scp=58149352414&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.108.520478
DO - 10.1161/STROKEAHA.108.520478
M3 - Article
C2 - 18787198
AN - SCOPUS:58149352414
SN - 0039-2499
VL - 39
SP - 3427
EP - 3430
JO - Stroke
JF - Stroke
IS - 12
ER -