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Application of Telemedicine in the Ambulance for Stroke Patients: A Systematic Review

Published online by Cambridge University Press:  25 October 2023

Fatemeh Sarpourian ,
Milad Ahmadi Marzaleh Open the ORCID record for Milad Ahmadi Marzaleh [Opens in a new window] ,
Seyed Ali Fatemi Aghda  and
Zahra Zare Open the ORCID record for Zahra Zare [Opens in a new window]
Fatemeh Sarpourian
Affiliation:
PhD Candidate of Health Information Management, Student Research Committee, Department of Health Information Technology, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
Milad Ahmadi Marzaleh
Affiliation:
Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
Seyed Ali Fatemi Aghda
Affiliation:
PhD Candidate of Medical Informatics, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
Zahra Zare*
Affiliation:
PhD Candidate in Health Care Management, Department of Health Care Management, School of Health Management and Information Sciences, Shiraz University of Medical Science, Shiraz, Iran
*
Correspondence: Zahra Zare School of Health Management and Information Sciences Shiraz University of Medical Sciences Shiraz, Iran E-mail: zahra.zare1993@gmail.com
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Abstract

Introduction:

The use of telemedicine for the prehospital management of emergency conditions, especially stroke, is increasing day by day. Few studies have investigated the applications of telemedicine in Emergency Medical Services (EMS). A comprehensive study of the applications of this technology in stroke patients in ambulances can help to build a better understanding. Therefore, this systematic review was conducted to investigate the use of telemedicine in ambulances for stroke patients in 2023.

Methods:

A systematic search was conducted in PubMed, Cochrane, Scopus, ProQuest, Science Direct, and Web of Science from 2013 through March 1, 2023. The authors selected the articles based on keywords and criteria and reviewed them in terms of title, abstract, and full text. Finally, the articles that were related to the study aim were evaluated.

Results:

The initial search resulted in the extraction of 2,795 articles. After review of the articles, and applying the inclusion and exclusion criteria, seven articles were selected for the final analysis. Three (42.85%) studies were on the feasibility and intervention types. Also, randomized trials, feasibility, feasibility and prospective-observational, and feasibility and retrospective-interventional studies were each one (14.28%). Six (85.71%) of the studies were conducted in the United States. The National Institutes of Health Stroke Scale (NIHSS) and RP-Xpress were the most commonly used tools for neurological evaluations and teleconsultations.

Conclusion:

Remote prehospital consultations, triage, and sending patient data before they go to the emergency department can be provided through telemedicine in ambulances. Neurological evaluations via telemedicine are reliable and accurate, and they are almost equal to in-person evaluations by a neurologist.

Keywords

ambulanceprehospitalstroketechnologytelemedicine
Type
Systematic Review
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 6 , December 2023 , pp. 774 - 779
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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Footnotes

Note: Fatemeh Sarpourian and Milad Ahmadi Marzaleh have had the same contribution and both are the first author.

References

Rogers, H, Chalil Madathil, K, Joseph, A, et al. Task, usability, and error analyses of ambulance-based telemedicine for stroke care. IISE Transactions on Healthcare Systems Engineering. 2021;11(3):192–208.Google Scholar
Nepal, G, Yadav, JK, Basnet, B, Shrestha, TM, Kharel, G, Ojha, R. Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal. BMC Neurol. 2019;19:1–9.10.1186/s12883-019-1378-3CrossRefGoogle ScholarPubMed
Kandimalla, J, Vellipuram, AR, Rodriguez, G, Maud, A, Cruz-Flores, S, Khatri, R. Role of telemedicine in prehospital stroke care. Curr Cardiol Rep. 2021;23(6):71.CrossRefGoogle ScholarPubMed
Harris, J. A review of mobile stroke units. J Neurol. 2021;268:3180–3184.CrossRefGoogle ScholarPubMed
Joseph, A, Chalil Madathil, K, Jafarifiroozabadi, R, et al. Communication and teamwork during telemedicine-enabled stroke care in an ambulance. Hum Factors. 2022;64(1):21–41.CrossRefGoogle ScholarPubMed
Bladin, CF, Bagot, KL, Vu, M, et al. Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care. BMJ Open. 2022;12(7):e052332.10.1136/bmjopen-2021-052332CrossRefGoogle ScholarPubMed
Dixon, M, Appleton, JP, Scutt, P, et al. Time intervals and distances travelled for prehospital ambulance stroke care: data from the randomized-controlled ambulance-based Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2). BMJ Open. 2022;12(11):e060211.10.1136/bmjopen-2021-060211CrossRefGoogle ScholarPubMed
Bugge, HF, Guterud, M, Bache, KC, et al. Paramedic Norwegian acute stroke prehospital project (ParaNASPP) study protocol: a stepped wedge randomized trial of stroke screening using the National Institutes of health stroke scale in the ambulance. Trials. 2022;23(1):113.10.1186/s13063-022-06006-4CrossRefGoogle ScholarPubMed
Cheshire, WP, Barrett, KM, Eidelman, BH, et al. Patient perception of physician empathy in stroke telemedicine. J Telemed Telecare. 2021;27(9):572–581.10.1177/1357633X19899237CrossRefGoogle ScholarPubMed
Croatti, A, Longoni, M, Montagna, S. Applying telemedicine for stroke remote diagnosis: the TeleStroke System. Procedia Computer Science. 2022;198:164–170.10.1016/j.procs.2021.12.224CrossRefGoogle Scholar
Johansson, A, Esbjörnsson, M, Nordqvist, P, et al. Technical feasibility and ambulance nurses’ view of a digital telemedicine system in pre-hospital stroke care–a pilot study. Int Emerg Nurs. 2019;44:35–40.CrossRefGoogle ScholarPubMed
Wu, T-C, Nguyen, C, Ankrom, C, et al. Prehospital utility of rapid stroke evaluation using in-ambulance telemedicine: a pilot feasibility study. Stroke. 2014;45(8):2342–2347.10.1161/STROKEAHA.114.005193CrossRefGoogle ScholarPubMed
Amadi-Obi, A, Gilligan, P, Owens, N, O’Donnell, C. Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment. Int J Emerg Med. 2014;7:1–11.10.1186/s12245-014-0029-0CrossRefGoogle Scholar
Tanguay, A, Dallaire, R, Hébert, D, Bégin, F, Fleet, R. Rural patient access to primary percutaneous coronary intervention centers is improved by a novel integrated telemedicine prehospital system. J Emerg Med. 2015;49(5):657–664.10.1016/j.jemermed.2015.05.009CrossRefGoogle ScholarPubMed
Caldarola, P, Gulizia, MM, Gabrielli, D, et al. ANMCO/SIT consensus document: telemedicine for cardiovascular emergency networks. European Heart Journal Supplements. 2017;19(suppl_D):D229–D243.CrossRefGoogle ScholarPubMed
Marzaleh, MA, Peyravi, M, Azhdari, N, Bahaadinbeigy, K, Sarpourian, F. Application of telerehabilitation for older adults during the COVID-19 pandemic: a systematic review. Disaster Med Public Health Prep. 2022;17:e402.CrossRefGoogle Scholar
Batistatos, MC, Tsoulos, GV, Athanasiadou, GE. Mobile telemedicine for moving vehicle scenarios: wireless technology options and challenges. J Network Computer Applications. 2012;35(3):1140–1150.10.1016/j.jnca.2012.01.003CrossRefGoogle Scholar
Zimmerman, C, Albanese-O’Neill, A, Haller, MJ. Advances in type 1 diabetes technology over the last decade. European Endocrinology. 2019;15(2):70.Google ScholarPubMed
Dike, FO, Mutabazi, JC, Ubani, BC, et al. Implementation and impact of mobile health (mHealth) in the management of diabetes mellitus in Africa: a systematic review protocol. BMJ Open. 2021;11(12):e047556.CrossRefGoogle Scholar
Biswas, M, Tania, MH, Kaiser, MS, Kabir, R, Mahmud, M, Kemal, AA. ACCU3RATE: a mobile health application rating scale based on user reviews. PloS One. 2021;16(12):e0258050.CrossRefGoogle ScholarPubMed
Rahnama, A, Roozbeh, N, Salimi Asl, A, Kazemi Gerashi, Z, Abbaszadeh, M, Dabiri, F. Factors related to childbearing in Iran: a systematic review. J Preventive Medicine. 2022;9(1):6–17.Google Scholar
Wu, T-C, Parker, SA, Jagolino, A, et al. Telemedicine can replace the neurologist on a mobile stroke unit. Stroke. 2017;48(2):493–496.CrossRefGoogle ScholarPubMed
Lippman, JM, Smith, SNC, McMurry, TL, et al. Mobile telestroke during ambulance transport is feasible in a rural EMS setting: the iTREAT Study. Telemedicine and e-Health. 2016;22(6):507–513.CrossRefGoogle Scholar
Geisler, F, Kunz, A, Winter, B, et al. Telemedicine in prehospital acute stroke care. J Am Heart Assoc. 2019;8(6):e011729.10.1161/JAHA.118.011729CrossRefGoogle ScholarPubMed
Belt, GH, Felberg, RA, Rubin, J, Halperin, JJ. In-transit telemedicine speeds ischemic stroke treatment: preliminary results. Stroke. 2016;47(9):2413–2415.10.1161/STROKEAHA.116.014270CrossRefGoogle ScholarPubMed
Itrat, A, Taqui, A, Cerejo, R, et al. Telemedicine in prehospital stroke evaluation and thrombolysis: taking stroke treatment to the doorstep. JAMA Neurol. 2016;73(2):162–168.10.1001/jamaneurol.2015.3849CrossRefGoogle Scholar
Bilotta, M, Sigal, AP, Shah, A, et al. A novel use of prehospital telemedicine to decrease door to computed tomography results in acute strokes. J Healthcare Quality (JHQ). 2020;42(5):264–268.CrossRefGoogle ScholarPubMed
Sonkin, R, Jaffe, E, Wacht, O, Morse, H, Bitan, Y. Real-time video communication between ambulance paramedic and scene–a simulation-based study. BMC Health Services Research. 2022;22(1):1–7.10.1186/s12913-022-08445-wCrossRefGoogle Scholar
Berlet, M, Vogel, T, Gharba, M, et al. Emergency telemedicine mobile ultrasounds using a 5G-enabled application: development and usability study. JMIR Formative Research. 2022;6(5):e36824.10.2196/36824CrossRefGoogle ScholarPubMed
Felzen, M, Beckers, SK, Kork, F, et al. Utilization, safety, and technical performance of a telemedicine system for prehospital emergency care: observational study. J Med Internet Res. 2019;21(10):e14907.10.2196/14907CrossRefGoogle ScholarPubMed
Schröder, H, Beckers, SK, Ogrodzki, K, et al. Tele-EMS physicians improve life-threatening conditions during prehospital emergency missions. Scientific Reports. 2021;11(1):14366.10.1038/s41598-021-93287-5CrossRefGoogle ScholarPubMed
Brunetti, ND, De Gennaro, L, Correale, M, et al. Pre-hospital electrocardiogram triage with telemedicine near halves time to treatment in STEMI: a meta-analysis and meta-regression analysis of non-randomized studies. Int J Cardiol. 2017;232:5–11.CrossRefGoogle ScholarPubMed
Dalesio, NM, Lester, LC, Barone, B, Deanehan, JK, Fackler, JC. Real-time emergency airway consultation via telemedicine: Instituting the pediatric airway response team board! Anesth Analg. 2020;130(4):1097–1102.10.1213/ANE.0000000000004635CrossRefGoogle ScholarPubMed
Magimel-Pelonnier, E, Marjanovic, N, Couvreur, R, Drugeon, B, Mimoz, O, Guenezan, J. Photography tele-transmission by regular ambulance staff for the management of mild traumatic injury: the NiCEPHORE randomized-controlled trial. Scand J Trauma Resusc Emerg Med. 2022;30(1):53.10.1186/s13049-022-01026-0CrossRefGoogle Scholar
Zhang, B, Li, D, Liu, Y, Wang, J, Xiao, Q. Virtual reality for limb motor function, balance, gait, cognition, and daily function of stroke patients: a systematic review and meta-analysis. J Advanced Nurs. 2021;77(8):3255–3273.10.1111/jan.14800CrossRefGoogle ScholarPubMed
Lumley, HA, Flynn, D, Shaw, L, et al. A scoping review of pre-hospital technology to assist ambulance personnel with patient diagnosis or stratification during the emergency assessment of suspected stroke. BMC Emerg Med. 2020;20(1):1–21.CrossRefGoogle ScholarPubMed
Yang, K, Hu, Y, Qi, H. Digital health literacy: bibliometric analysis. J Med Internet Res. 2022;24(7):e35816.10.2196/35816CrossRefGoogle ScholarPubMed
Hyder, MA, Razzak, J. Telemedicine in the United States: an introduction for students and residents. J Med Internet Res. 2020;22(11):e20839.10.2196/20839CrossRefGoogle ScholarPubMed
Zachrison, KS, Boggs, KM, M Hayden, E, Espinola, JA, Camargo, CA. A national survey of telemedicine use by US emergency departments. J Telemed Telecare. 2020;26(5):278–284.CrossRefGoogle ScholarPubMed
Waseh, S, Dicker, AP. Telemedicine training in undergraduate medical education: mixed-methods review. JMIR Med Edu. 2019;5(1):e12515.CrossRefGoogle ScholarPubMed
Shuaib, A, Jeerakathil, T. The mobile stroke unit and management of acute stroke in rural settings. CMAJ. 2018;190(28):E855–E858.10.1503/cmaj.170999CrossRefGoogle ScholarPubMed
Kazemnejad-Leili, E, Rezaei, S, Hosseini-Nejad, M, Bakhshayesh-Eghbali, B, Saberi, A, Keshavarz, P. The applicability, concurrent validity, and internal consistency reliability of the Persian version of the National Institutes of Health stroke scale (NIHSS): evidences for gender differences. Caspian Journal of Neurological Sciences. 2016;2(1):18–28.Google Scholar
Finocchi, C, Balestrino, M, Malfatto, L, Mancardi, G, Serrati, C, Gandolfo, C. National Institutes of Health Stroke Scale in patients with primary intracerebral hemorrhage. Neurol Sci. 2018;39:1751–1755.CrossRefGoogle ScholarPubMed
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