REACH: Clinical feasibility of a rural telestroke network

David C. Hess, Samuel Wang, William Hamilton, Sung Lee, Carol Pardue, Jennifer L. Waller, Hartmut Gross, Fenwick Nichols, Christiana Hall, Robert J. Adams

Research output: Contribution to journalArticlepeer-review

147 Scopus citations


Background and Purpose - Development of stroke networks is critical to bringing guideline-driven stroke care to rural, underserved areas. Methods - A Web-based telestroke tool, REACH, was developed to provide a foundation for a rural stroke network that delivered acute stroke consults 24 hours per day 7 days per week to 8 rural community hospitals in Georgia. Results - There were 194 acute stroke consults delivered. Thirty patients were treated with tissue plasminogen activator (tPA). The mean National Institutes of Health Stroke Score (NIHSS) was 15.4, and the median NIHSS was 12.5. The mean onset to treatment time (OTT) was 122 minutes. The OTT dropped from 143 minutes in the first 10 patients treated to 111 minutes in last 20 patients. Of the 30 patients treated with tPA, 23% (7) were treated in ≤90 minutes and 60% (18) were treated within 2 hours. There were no symptomatic intracerebral hemorrhages. Conclusions - The REACH telestroke system permits the rapid and safe use of tPA in rural community hospitals. Over time, the system became more efficient and OTT decreased.

Original languageEnglish (US)
Pages (from-to)2018-2020
Number of pages3
Issue number9
StatePublished - Sep 2005


  • Stroke, acute
  • Stroke, ischemic
  • Telemedicine
  • Tissue plasminogen activator

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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