Hess DC et al. (2005) REACH: clinical feasibility of a rural telestroke network. Stroke 36: 2018–2020

A lack of resources in US rural hospitals often leads to acute stroke patients being treated inadequately or having to travel to distant regional hospitals, thereby delaying treatment. To overcome these problems, a recent study advocates use of the REACH telestroke system, which enables rural doctors and distant stroke specialists to interact over a broadband Internet connection. The specialist can access CT scans and patient video clips to calculate stroke severity and make recommendations for treatment. Advice can be given on the suitability for each patient of the thrombolytic agent tissue plasminogen activator (tPA), early use of which has been shown to correlate with better outcome.

Hess et al. reviewed 194 stroke patients evaluated using the REACH system between March 2003 and May 2005 in a network of eight rural hospitals in Georgia, USA. The time from stroke onset to treatment with tPA was a mean of 122 min; this decreased as users' familiarity with the system increased. Nearly a quarter of the 30 patients given tPA were treated within ≤90 min of admission, and more than half within 2 h. CT or MRI scans were carried out within 36 h of tPA administration. Patient response was good, with low in-hospital mortality, no symptomatic intracerebral hemorrhages, and marked improvement within 24 h in 60% of tPA-treated patients.

By providing access to a 24-hour stroke team, the REACH system enables rural hospitals to provide rapid, safe and effective treatment with tPA. The costs of setting up and maintaining the system are low, making it an extremely feasible option.