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Publication Date
2-2019
Disciplines
Neurology
Abstract
Purpose: Telestroke has been shown to improve acute ischemic stroke (AIS) care in rural settings, but few studies have examined the impact of telestroke in an urban setting. In an urban area, there was a planned transition from an outpatient-based acute stroke provider pool to a centralized telehealth team of neurovascular and neurocritical care providers. This study assessed the impact of this change by comparing patient outcomes during three time periods: pre-initiation (PRE), transition after initiation (TRAN) and post-transition (POST).
Methods: Data for AIS patients 18 and older from five urban hospitals were used. Outcomes were hospital length of stay (LOS) and percentage of patients who had a door-to-needle time (DTN) <45 and <60 minutes, IV-alteplase or endovascular treatment, an IV-alteplase-related complication, and a discharge other than to home or rehab. Generalized linear and Cox proportional hazard models were used to compare outcomes for patients discharged during PRE (June 2015 - June 2016), TRAN (July 2016 – December 2016) and POST (January 2017 – March 2018) time periods adjusting for arrival mode, gender, admit NIHSS, age, and arrival time.
Results: Of 4,984 patients that met inclusion criteria, there were 2,075 treated in PRE, 1,052 in TRAN and 1,857 in POST. After adjustment, TRAN patients were 1.77 times more likely to be treated with IV-alteplase than PRE patients (p=.013). POST patients were 2.46 times more likely to receive endovascular treatment than PRE patients (p=.009) and 2.07 times as likely as those in the TRAN period (p=.007). Patients in the TRAN period were 1.63 times more likely to be treated with IV alteplase in <60 minutes (p<.001) and 2.22 times more likely in the POST period (p=.002) compared to those in PRE. There were no significant differences in the odds of being treated in <45 minutes, LOS, or discharge disposition.
Conclusion: A transition to a specialty stroke care through a telestroke network showed improvements in treatment rates and percentage of patients with DTN less than 60 minutes.
Clinical Institute
Neurosciences (Brain & Spine)
Specialty/Research Institute
Neurosciences
Conference / Event Name
International Stroke Conference
Location
Honolulu, HI, United States
