Alaska's medical centers go online to diagnose strokes

Posted: Monday, May 18, 2009

Physicians racing to rescue patients exhibiting signs of stroke from long-term disabilities or death now have a new telemedicine weapon in their arsenal to stop the fourth leading cause of death in Alaska.

The remote evaluation of acute ischemic, or REACH, stroke diagnosis and evaluation system, introduced in early May by Providence Alaska Medical Center, allows a neurologist based in the Anchorage hospital to see and evaluate patients in Soldotna, Seward, Valdez, Kodiak, Juneau and Homer via a laptop computer.

Medical staff in any of these six communities can use a Web browser to request a consult and are quickly connected via Internet to an Anchorage neurologist using a laptop to do a visual examination of the patient.

This so-called REACH hub-and-spoke network, though new to Alaska, is already in use at more than 80 hospitals nationwide, allowing neurologists in hub hospitals to quickly evaluate patients at smaller hospitals where no neurologist is available.

The biggest barrier to effective stroke treatment in Alaska currently is the time lapse between when the patient shows symptoms of stroke, is diagnosed and then treated.

Patients with relatively uncomplicated strokes may be hospitalized for two to five days, at a cost of $20,000 to $50,000, according to Christie Artuso, director of neuroscience services at Providence. Most of these patients will also have high blood pressure, diabetes, smoke or excessive weight, she said.

The technology allows the neurologist at the hub hospital to use a computer to closely examine the patient's visual symptoms, including their eye pupils, to determine if a stroke is occurring and, if so, what kind.

About 87 percent of all strokes are ischemic, caused by a blood clot or blockage in an artery. Hemorrhagic strokes, caused when weakened blood vessels in the brain rupture, account for the other 13 percent.

There are also transient ischemic attacks, commonly referred to as TIAs, a warning that a stroke is likely to occur. TIAs occur when a clot develops but dissolves or dislodges on its own.

Artuso said the wireless Web-based system is being ramped up slowly to work out any technology issues in this system.

Emergency medical technicians and emergency room physicians can administer stroke tests, but neurologists and stroke specialists can most accurately diagnose the patient and prescribe treatment to dissolve blood clots.

While strokes can happen to anyone, regardless of age, the average age for a stroke is 55 to 65 years old, said Artuso, an advanced practice nurse who also holds a doctorate in education.

Tobacco use, high blood pressure, an abnormal heart rhythm involving the upper two chambers of the heart or a narrowing of the artery that supplies blood to the head and neck are some risk factors that increase the possibility of stroke. Other common factors include high cholesterol and diabetes.

Alaska Regional Hospital, Alaska's first Joint Commission-certified stroke program, already has in place a system calls PACS, or picture archive communication system.

Neurologists at Alaska Regional can receive computerized axial tomography (CAT scan) images of the brain for review by neurologists and neurosurgeons to identify evidence of stroke.

This capability of image sharing is available only between Alaska Regional and other facilities statewide with CAT scan capabilities, such as Fairbanks Memorial Hospital, Juneau's Bartlett and Mat-Su Regional hospitals, said spokeswoman Kjerstin Lastufka.

REACH is one of more than 200 telemedicine spoke systems available in the United States.

"We picked REACH because it has been utilized in several states with rural populations," Artuso said. "It has been shown to be reliable with minimal technology issues."

Reliable as it is, the REACH system will be able to help only those patients in communities whose hospitals are connected to that system.

Educators at Providence, Alaska Regional, the Alaska Tribal Health Consortium, the American Heart Association and many other medical providers meanwhile are continuing to educate the public about warning signs of stroke.

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