The purpose of this project is to develop and prospectively evaluate methods to increase the numbers of stroke patients treated acutely with thrombolysis and to decrease the time to patient treatment using a new remote video imaging technique. This proposed research design would test the hypothesis that the """"""""Stroke Team Remote Evaluation using a Digital Observation Camera (STRokE DOC)"""""""" video link system can become an effective and efficient method for stroke experts to support other types of physicians at remote hospital sites, by providing real time stroke consultations. We will determine the feasibility, reliability, and validity of the 'STRokE DOC' video link system in chronic, stable patients. Using novel technology developed by our collaborators, we will compare live to video patient examinations. Live examinations will be conducted by a NIHSS certified examiner in our outpatient clinic, while a second certified examiner will observe using the STRokE DOC video link. We hypothesize reasonable reliability (Kappa >0.80). Then we will determine whether remote Internet video consultation increases the numbers of stroke patients treated with tPA, and decreases time to treatment for these patients. The camera system will be placed in a remote hospital Emergency Department setting and patients with acute neurological deficits will be examined via the STRokE DOC video link system. We will tabulate total number of thrombolytics administered, and time to treatment, when the STRokE DOC system is in place using a 2x2 hospital crossover design. We hypothesize that the number of appropriate thrombolytic treatments will increase, and times to treatment will decrease, in hospitals with the STRokE DOC system, compared to the same hospitals without the system. We will determine whether the utility of the system is reproducible by placing cameras in additional emergency rooms, including underserved urban areas. We hypothesize that the number of 2-hour treatments will increase after implementation of the STRokE DOC system in a variety of settings.
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