Supplementaltables

Table e-1. Pooled rates of sICH, mortality and functional independence across the two consultative models used in the included studies and in patients treated at an academic stroke center

Variable / Telemedicine-guided
(n=518) / Telephone-only
(n=33) / Stroke center
(n=1312)
sICH (95% CI)* / 4.9% (2.9% - 8.0%)† / NA / 8.4% (6.9% - 10.1%)| |
Mortality at 3 months (95% CI)* / 18.0% (14.3% - 22.4%)‡ / 12.1% (4.2% - 27.9%)§ / 11.3% (9.6% - 13.2%)#
Functional independence at 3 months (95% CI)* / 36.1% (31.2% - 41.5%)‡‡ / 28.1% (15.4% - 45.5%)§§ / 35.8% (33.1% - 38.7%)##

sICH indicates symptomatic intracerebral hemorrhage; CI, confidence interval; NA, not available.

*Adjusted Wald method; †on the basis of 307 patients1-4; ‡ on the basis of 345 patients2,4-7; ‡‡ on the basis of 332 patients2,4-7;§on the basis of 33 patients6,7; | | on the basis of 1180 patients1-4; # on the basis of 1173 patients2,4,5; §§on the basis of 32 patients6,7; ##on the basis of 1123 patients2,4,5

Table e-2. Quality assessment of the included non-randomized studies using the Downs and Black checklist

Audebert et al.1, 2006 / Sairanen et al.2, 2011 / Schwab et al.5, 2007 / Switzer et al.3, 2009 / Zaidi et al.4, 2011
Q1: Aim clearly described? / Yes / Yes / Yes / Yes / No
Q2: Outcomes clearly described? / No / Yes / Yes / Yes / Yes
Q3: Patients characteristics clearly described? / Yes / Yes / Yes / No / Yes
Q4: Interventions clearly described? / Yes / Yes / Yes / Yes / Yes
Q5: Principal confounders clearly described? / Yes / Partially / Yes / No / Yes
Q6: Main findings clearly described? / Yes / Yes / Yes / Yes / Yes
Q7: Random variability for main outcome provided? / Yes / No / No / No / No
Q8: Adverse events reported? / Yes / Yes / Yes / Yes / Yes
Q9: Loss-to-follow up reported? / Yes / Yes / Yes / No / No
Q10: Actual p-value reported? / Yes / Yes / Yes / Yes / Yes
Q11: Sample asked to participate representative of the population? / Yes / Yes / Yes / Yes / Yes
Q12: Sample agreed to participate representative of the population? / Yes / Yes / Yes / Yes / Yes
Q13: Staff participating representative of the patients’ environment? / Yes / Yes / Yes / Yes / Yes
Q14: Attempt to blind participants? / No / No / No / No / No
Q15: Attempt to blind assessors? / No / No / No / No / No
Q16: Data dredging results stated clearly? / No / No / No / No / No
Q17: Analysis adjusted for length of follow up? / Unable to determine / Yes / Yes / Unable to determine / Yes
Q18: Appropriate statistics? / Yes / Yes / Yes / Yes / Yes
Q19: Reliable compliance? / Yes / Yes / Yes / Yes / Yes
Q20: Accurate outcome measures? / Yes / Yes / Yes / Yes / Yes
Q21: Same population? / Yes / Yes / Yes / Yes / Yes
Q22: Participants recruited at the same time? / Yes / No / Yes / Yes / Yes
Q23: Randomised? / No / No / No / No / No
Q24: Adequate allocation concealment? / No / No / No / No / No
Q25: Adequate adjustment for confounders? / No / No / No / No / No
Q26: Loss of follow up reported? / Yes / Yes / Yes / No / No
Q27: Power calculation? / No / No / No / No / No

Table e-3. Quality assessment of the included randomized studies using the Cochrane risk of bias assessment tool (ACROBAT)

Demaerschalk et al.6, 2010 / Meyer et al.7, 2008
Adequate sequence generation? / Yes / Yes
Allocation concealment? / Yes / Yes
Blinding? / No / No
Incomplete outcome data addressed? / Yes / Yes
Free of selective reporting? / Yes / Yes
Free of other bias? / Yes / Yes

Supplemental reference section

1.Audebert HJ, Kukla C, Vatankhah B, et al. Comparison of tissue plasminogen activator administration management between Telestroke Network hospitals and academic stroke centers: the Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany. Stroke. 2006;37:1822-7.

2.Sairanen T, Soinila S, Nikkanen M, et al. Two years of Finnish Telestroke: thrombolysis at spokes equal to that at the hub. Neurology. 2011;76:1145-52.

3.Switzer JA, Hall C, Gross H, et al. A web-based telestroke system facilitates rapid treatment of acute ischemic stroke patients in rural emergency departments. J Emerg Med. 2009;36:12-8.

4.Zaidi SF, Jumma MA, Urra XN, et al. Telestroke-guided intravenous tissue-type plasminogen activator treatment achieves a similar clinical outcome as thrombolysis at a comprehensive stroke center. Stroke. 2011;42:3291-3.

5.Schwab S, Vatankhah B, Kukla C, et al. A Long-term outcome after thrombolysis in telemedical stroke care. Neurology. 2007;69:898-903.

6.Demaerschalk BM, Bobrow BJ, Raman R, et al. Stroke team remote evaluation using a digital observation camera in Arizona: the initial mayo clinic experience trial. Stroke. 2010;41:1251-8.

7.Meyer BC, Raman R, Hemmen T, et al. Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. Lancet Neurol. 2008;7:787-95.