Abstract WP285: Comparison of Telestroke versus In-person Treatment of Acute Stroke by the Same Vascular Neurologists at a Comprehensive Stroke Center

Abstract

Introduction: Telemedicine (TM) has enabled rapid treatment of acute ischemic stroke with intravenous (IV) t-PA in remote centers where vascular neurologists are scarce. We are a Comprehensive Stroke Center (CSC) serving a large rural community in Central Texas. 24/7 stroke coverage is provided by three vascular neurologists, who evaluate patients at the CSC in-person from 8am to 4pm on weekdays and over telemedicine during all other times. This provides a unique opportunity to isolate and compare the effects of telemedicine to in-person treatment. Objective: Compare door-to-needle (DTN) times of the same vascular neurology group, over TM versus in-person evaluation Methods: We retrospectively reviewed time metrics of patients treated with IV t-PA between October 2017 and June 2017. Patients treated outside of the emergency department were excluded. Results: In the study timeframe, 107 patients received IV t-PA, 34 (31.8%) of whom were treated over TM. There was no statistically significant difference in median DTN time between patients treated with IV t-PA in-person versus over TM (50 min, IQR 19.25 versus 47 min, IQR 24, p=0.193; Table 1). There was also no significant difference in door-to-CT and door-to-lab results between the two groups (Table 1). Conclusion: Our study demonstrates that our vascular neurology group achieves similar DTN times for patients our CSC regardless of whether they are evaluated on-site versus through TM. This suggests that the application of TM itself does not affect DTN times. Limitations include the usual hospital variability seen during nights and weekends.