Abstract
Introduction: Telestroke provides vascular neurology expertise to hospitals without onsite neurologists, but little is known about the temporal trends in use and timeliness of consults by spokes. We describe a telestroke network of 2 comprehensive stroke center (CSC) hubs and associated spokes. Methods: Telestroke consults were analyzed from 2003 to 2018. Trends in volume of consult requests and IV-tPA use were determined by generalized estimating equations, trends in treatment times by Kendall’s τβ nonparametric test, and associations between treatment metrics and utilization of telestroke by linear regressions. Results: The 2 hubs served 43 spokes and performed 12,808 telestroke consults of which 16% received tPA and 10% were judged eligible for thrombectomy. Spokes were in the network an average of 7.87 years, 1.82 spokes joined per year, and 1.03 exited per year. There was an overall increase in consults annually (p for temporal trend <0.0001) and patients treated with IV-tPA (p < 0.0001). Over the study period, time from last seen well to ED arrival time (KT coefficient 0.88, p <0.0001) and last seen well to consult request time (KT coefficient 0.28, p <0.0001) increased, however in hospital performance improved with decreasing times from ED arrival to IV-tPA (KT -0.13, p <0.0001), time of request to callback (KT -0.05, p <0.0001), and consult to IV-tPA administration (KT -0.09, p <0.0001) . The number of consults requested by a spoke and the number treated with IV-tPA at each spoke were positively associated (p=0.0002). Discussion: Telestroke was well-accepted by the spokes and utilization increased over time, with a net increase in spokes served per year. Higher consult utilization was associated with increased treatment with IV-tPA. ED time metrics have improved significantly. Being active in a telestroke network is associated with more stroke treatment which the spokes are delivering in a timely manner. Replication of these findings in other networks is warranted.
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