Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Evaluating the Safety and Efficacy of Telemedicine Neurology Assessments on a Mobile Stroke Unit: Protocol for a Randomised Trial (#126)

Vignan Yogendrakumar 1 , Anna H Balabanski 1 2 , Hannah Johns 3 , Leonid Churilov 1 3 , Henry Zhao 1 , Skye Coote 1 , Alexandra Warwick 1 , Amy McDonald 1 , Bruce CV Campbell 1 , Francesca Langenberg 1 , Leigh Branagan 4 , Waseem Siddiqui 4 , Andrew Bivard 1 , Damien Easton 1 , Stephen M Davis 1 , Geoffrey A Donnan 1
  1. Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
  2. Department of Neuroscience, The Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
  3. University of Melbourne, Melbourne, Victoria, Australia
  4. Ambulance Victoria, Melbourne, Victoria, Australia

Background: Stroke is the third most common cause of death in Australia. Early treatment leads to improved stroke outcomes. Mobile Stroke Units (MSUs) have been shown to deliver faster patient care, resulting in improved clinical outcomes and reduced disability. However, costs associated with staffing currently limit their use to densely populated cities.

Aims: Using the Melbourne MSU, we aim to validate a MSU telemedicine model as safe, timely, and resource-effective compared to a traditional onboard neurologist model. We hypothesise that the telemedicine model of care will provide superior resource efficiency without compromising patient care.

Methods: This study is a prospective randomized single-centre trial of a MSU telemedicine (using Zeus) versus an onboard neurologist staffing model using prospective designation of randomly permuted days onboard or a telemedicine neurologist. We will enrol all patients assessed on the MSU aged ≥18y with stroke symptom onset <24h. The primary outcome will be the probability that a randomly selected participant in the telemedicine arm will have a better outcome than a randomly selected participant in the onboard arm. This will be measured using a desirability of outcome ranking design, a novel trial design involving, in order of importance: (1) safety; (2) scene-to-decision time metrics; (3) resource utilisation. All participants within each arm will be compared to those in the other, resulting in a "win, loss, or draw" for telemedicine, compared with the onboard arm.

Results: We hypothesise the telemedicine intervention will result in a "win/draw/loss" distribution of 0.5/0.2/0.3 corresponding to Win Odds=1.5. A sample size of 270 patients, recruited over 6-9 months, and accounting for 10% non-evaluable data, will yield a power of 0.8.

Conclusion: Demonstrating superior resource efficiency of a telemedicine neurologist without compromising patient care will enable the broader utilisation of MSUs across Australia, improving equity in access to time-critical, lifesaving stroke care.