Abstract
Background: Published data suggest that the faster acute stroke patients are treated with IV alteplase the better they do post discharge. Telestroke allows community hospitals to access stroke expertise in the management of acute stroke patients. In a real-world practice setting, we assessed the influence of a regional standardized telestroke program among community hospitals on door-to-needle (DTN) time and clinical outcomes. Methods: In January 2016, a new standardized acute telestroke program for 21 stroke centers in an integrated healthcare system was launched. It included immediate evaluation by a stroke neurologist via video, an expedited IV alteplase treatment program, rapid CT angiographic investigation, and expedited transfer and treatment for patients with large vessel occlusion. We compared patient characteristics, DTN times, length of stay (LOS), discharge outcomes, and 90-day mortality between those treated with IV alteplase pre- (July 2013 to June 2015) to post-telestroke program (January 2016 to December 2017). Results: Post-implementation of the telestroke program, more patients were treated with alteplase (Table). Median DTN time and LOS were shorter. A greater percentage of patients were discharged home (57.3% in post-telestroke vs. 12.1% in pre, p<0.001). In-hospital mortality was higher in post-telestroke compared to pre. However, symptomatic hemorrhage rates were not significantly different, at 4.5% in 2014 pre-EXPRESS, 4.3% in 2016 and 3.2% in 2017 post-EXPRESS. In addition, 90-day mortality was not different between pre- and post-telestroke (Table). Conclusions: Implementation of a regional standardized telestroke program in a community setting increased utilization of alteplase, improved DTN time, decreased length of stay and significantly increased the chances of patients going home. Further analyses are needed to understand the significant contributing factors to the success of this program.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
