Telemedicine-supported Management for Acute Ischemic Stroke (TOGETHER)
Telemedicine-supported Management of Acute Ischemic Stroke in the Basic-level Hospitals
Telemedicine-supported stroke care can provide standardized guidance to hospitals and regions with limited medical resources, thereby improving treatment outcomes for stroke patients in these areas. While this approach has been widely adopted in many developed countries, its efficacy in guiding basic-level hospitals to manage acute ischemic stroke requires further investigation through large-scale, high-quality studies.
This study focused on patients with acute ischemic stroke who sought treatment at basic-level hospitals, aiming to investigate the efficacy and safety of treating acute ischemic stroke with telemedicine-supported management. Hospitals assigned to the experimental group received remote consultation guidance, quality control and professional training from expert teams at leading stroke centers, China National Center for Neurological Disorders. Hospitals in the control group did not receive telemedicine-supported management.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Xunming Ji
- Phone Number: 01083198962
- Email: jixm@ccmu.edu.cn
Study Contact Backup
- Name: Chuanjie Wu
- Phone Number: 01083199439
- Email: wuchuanjie@ccmu.edu.cn
Study Locations
-
-
Beijing Municipality
-
Beijing, Beijing Municipality, China, 100053
- Recruiting
- Xuanwu Hospital
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Hospital Inclusion Criteria:
- Basic-level hospitals in China (Definition: Hospitals classified as secondary-level (Grade II) or below under China's Hospital Grading Management Standards, or hospitals located in counties/county-level cities).
- Equipped with an emergency department and neurology ward capable of admitting stroke patients.
- Equipped with CT and/or MRI capable of diagnosing AIS.
- Equipped with intravenous thrombolytic drugs for acute ischemic stroke.
Patient Inclusion Criteria:
- Age ≥ 18 years.
- Diagnosed with acute ischemic stroke.
- CT/MRI confirms absence of intracerebral hemorrhage.
- Onset of stroke symptoms ≤ 4.5 hours.
- pre-stroke mRS score ≤1.
- Informed consent obtained from patient or their legal representative.
Exclusion Criteria:
Hospital Exclusion Criteria:
- Admitting fewer than 10 patients with acute ischemic stroke per month.
- Currently participating in other clinical trials that may interfere with this trial.
Patient Exclusion Criteria:
- Presence of contraindications for intravenous thrombolysis according to AHA/ASA guidelines
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Telemedicine-Supported Group
Receive remote guidance from expert stroke centers for treatment of patients with intravenous thrombolysis, along with quality control for standardized workflow support, and professional training.
|
Receive round-the-clock 7×24h remote consultation guidance from expert teams at leading stroke centers, covering patient triage and initial assessment, thrombolysis decision-making, and treatment guidance.
Undergo quality control for standardized workflow implementation, and professional training.
|
|
No Intervention: Standard Treatment Group without Telemedicine-Supported Management
Control-group patients will receive routine stroke care at their primary care hospitals, with no remote consultation, study-related quality control, or extra training.
Care will follow the hospitals' usual protocols, including emergency assessment, neurological evaluation, imaging, and intravenous thrombolysis.
Hospitals may continue their regular stroke-related training during the study to reflect real-world practice.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Proportion of patients with mRS scores of 0-1
Time Frame: 90 days
|
90 days
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Intravenous thrombolysis rate
Time Frame: 4.5 hours
|
4.5 hours
|
|
|
mRS score
Time Frame: 90 days
|
Ranges from 0 to 6 points, with lower scores indicating better functional outcome.
|
90 days
|
|
Door-to-(thrombolysis)needle-time
Time Frame: 4.5 hours
|
The time calculation begins when the patient arrives at the hospital and ends upon receiving thrombolytic therapy.
The theoretical range is 0 to 270 minutes.
|
4.5 hours
|
|
Rate of endovascular therapy receipt among eligible patients
Time Frame: 24 hours
|
24 hours
|
Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Proportion of sICH
Time Frame: Within 36 hours of thrombolysis
|
The time frame is within 36 hours after thrombolysis in patients.
Symptomatic intracranial hemorrhage occurring during this period is considered an endpoint event.
If the patient is discharged within 36 hours, the endpoint event is observed during the hospitalization period.
|
Within 36 hours of thrombolysis
|
|
Proportion of any type of ICH
Time Frame: Within 36 hours of thrombolysis
|
The time frame is within 36 hours of thrombolysis administration.
Any type of intracerebral hemorrhage occurring during this period is considered an endpoint event.
If the patient is discharged within 36 hours, the endpoint event is observed during the hospitalization period.
|
Within 36 hours of thrombolysis
|
|
All-cause mortality rate
Time Frame: 90 days
|
90 days
|
Collaborators and Investigators
Sponsor
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- TOGETHER
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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