Acute Stroke Trial Enrollment through a Telemedicine Network: A 12-Year Experience

Background: A major barrier to acute stroke trial enrollment is timely access to participating centers. Establishing referral relationships via telemedicine may broaden trial access. We sought to understand the utilization of telemedicine in trial enrollment at a large academic center. Methods: This is a single center, retrospective review of subjects consecutively enrolled into cerebrovascular trials requiring urgent consent between January 2005 and December 2016. Subjects were classified to either direct presentation to hub hospital, or transfer from spoke hospitals. We used Pearson linear correlation and a simple linear regression model to describe the relationship between annual trial enrollment rate and the number of spoke sites capable of audio-video evaluation (AVR) as a proxy for the size of the telemedicine network. We correlated the annual increase in enrollment with that of each group using parametric and nonparametric analysis. Results: Sixteen trials met our criteria, enrolling 299 subjects: 117 in the hub group and 182 in the spoke group. There was a direct relationship between the number of AVR-capable sites and annual trial enrollment rate (P = <.05). Annual increase in spoke enrollment was higher compared to hub enrollment (15.55 ± 11.30 versus 0.68 ± 1.03, P <.0005) and better correlated with total increase in enrollments (0.98 versus 0.94, P <.0001). Conclusions: Telemedicine networks are a major resource for trial enrollment. Expanding the use of remote enrollment could expedite the completion of acute cerebrovascular trials.