Abstract W P213: ,,Door-to-needle-,, Or ,,Onset-to-treatment-time”? What Is The Key Marker To Assess Telestroke Care?

Abstract

Background: Telestroke networks apply specialized stroke care in rural areas. A short “onset-to-treatment-time” (OTT) reduces the risk of disability and death after thrombolysis. To minimize OTT the “door-to-needle-time” (DNT) should be less than 60 minutes. However, this is not achieved in many telestroke networks. We postulate that telestroke networks can accomplish adequate OTT′s despite of extended DNT′s. Methods: We retrospectively analyzed data of consecutive stroke patients treated with thrombolytics within the Stroke-East-Saxony-Network (SOS-NET) from 07/2007 to 07/2012. Time of symptom onset, hospital admission, CT scan, teleconsultation and thrombolysis were derived from in-patient records. DTN and OTT time were calculated. We report median values and interquartile range (IQR) as well as symptomatic intracranial hemorrhage (sICH) by ECASS-2-criteria. Results: 1659 patients of 3172 teleconsultations had an acute ischemic stroke. Thrombolysis was recommended in 688 and performed in 657 patients. Complete data were available for 368 patients (median age 77 [IQR) 12] years, NIHSS score 12 [IQR 10]). Twenty-three patients (6.3%) suffered sICH. Time from symptom onset to hospital admission was 63 minutes (IQR 47) and hospital admission to CT scan 16 minutes (IQR 15). The teleconsultation took 20 minutes (IQR 13) and time from teleconsultation to treatment was 40 minutes (IQR 22). DNT was 70 (IQR 33), OTT 143 minutes (IQR 72). Discussion: Compared to a primary stroke center DNT was longer in the SOS-NET (70 minutes [IQR 33] vs. 20 minutes [IQR 18]) which could be explained with less expertise of the affiliated hospitals and duration of teleconsultation. However, OTT was 143 minutes [IQR 72] and not different to OTT in this single center (120 [IQR 90]) or in a large regional registry (144 minutes [IQR 115-170]), respectively. This is probably because telestroke care prevents transportation of patients. Conclusion: OTT is more important in the assessment of stroke care in rural areas than DNT alone. Telestroke care can implement adequate OTT despite delayed DNT. Nevertheless, DNT still got room for improvement.