Abstract T P274: Stroke Mimics in Telestroke

Abstract

Background and Issues: Wake Forest Baptist Medical Center in Winston-Salem, N.C. deployed a telestroke network system in January of 2010 to provide 24/7 access to a stroke specialist for rural communities. There are twelve hospitals in the network at the present time with tPA administration rate currently at 43%. The potential advantage of face-to-face examination is that it is potentially easier to identify stroke mimics. The frequency of false-positive diagnosis of ischemic stroke has been estimated at approximately 1-14%. It has been demonstrated that patients with mimics have a low tPA related complication rate but it is relevant that these patients have received an unnecessary and potentially harmful treatment. Methods: We reviewed the data on 436 patients who received telestroke consultations between 1/2010 and 9/2012. We retrieved information on the following: number of mimics, presenting complaints and clinical characteristics of patients and outcomes. Results: There were 49 drip and ship patients, with 14% of patients being diagnosed as stroke mimics. The percentage of stroke mimics given thrombolytic therapy via the telestroke network was low and is similar to what has been reported elsewhere. Our results concur with previous studies, proving the feasibility and safety of treating acute ischemic stroke via telemedicine. Even though the administration of tPA in the mimic patient has a low complication rate it provides an unnecessary (medically and financially) intervention and is a potentially harmful treatment. Our stroke team set forth a goal to decrease the rate of treating stroke mimic patients via our telestroke network. Two strategies were developed: first, an educational program was provided for each network hospital regarding neurological assessment and differential findings of ischemic stroke and a stroke mimic, and second, case studies of stroke mimic patients were presented and discussed at our quarterly telestroke conferences. These educational endeavors have decreased the number of stroke mimics that are treated with tPA via our telestroke network from 14% to 9%.