Abstract 10: Outcomes of Drip-and-Stay Telestroke Patients at Spoke Sites With Rehabilitation Units

Abstract

Background and Purpose: In spite of the increase of thrombolysis treatment rates at remote hospitals (spoke) due to implementation of telestroke systems, only 25% of telestroke patients who received tissue plasminogen activator (tPA) are transferred to a Comprehensive Stroke Center (CSC) in the United States. This leaves 3 out of 4 treated patients to receive their post-stroke care at telestroke spoke sites. As post-stroke rehabilitation is a pivotal component of recovery, we aimed to report outcomes of acute ischemic stroke (AIS) patients who received thrombolytic therapy, yet remained at a spoke hospital with a rehabilitation unit (RU). Methods: This was a retrospective review of the telestroke registry at our institution from January 2016 through July 2019. We included patients who received intravenous tPA at spoke sites and were not candidates to be transported to a CSC for mechanical thrombectomy (Drip-and-Stay paradigm). We compared baseline characteristics, discharge disposition, and excellent outcome [defined as a 90-day Modified Rankin Scale (mRS) of 0-1] of patients who remained at spoke sites with a RU to patients at spoke sites without a RU. A logistic regression model was used to assess the effect of RU on the possibility of having excellent outcomes controlling for confounding factors. Results: Of the 740 eligible AIS patients during the study period, 40% (n=294) received post-stroke care at a spoke with a RU. There were no significant differences in patient age, sex, admission NIHSS, door to needle times, or length of stay between patients in both groups. More patients in the spoke with rehabilitation units were discharged home (62% vs. 52%, P=0.001). Excellent long-term functional outcome was reported in 66% (n=193) of patients remaining at spoke sites with RU versus 58% (n=285) at those without RU (P=0.033). On multivariate analysis, RU was an independent predictor of having excellent outcomes (OR 2.02, 95% CI 1.42-2.87, P<0.001). Conclusions: Our study indicates a higher likelihood of both favorable discharge outcome and excellent long-term functional outcome in drip-and-stay patients who receive their post-stroke care at spoke sites with RU.