Abstract WP388: Inpatient Teleneurology Follow-Up Has Similar Outcomes to In-Person Neurology and Provides an Alternative to Transfer

Abstract

Introduction: Community emergency departments (EDs) often transfer ischemic stroke (IS) patients for lack of neurology coverage, burdening patients and accepting facilities. Telestroke (TS) improves acute stroke care access, but data lack on inpatient teleneurology follow-up (TNF) care. We hypothesized that IS patients evaluated in the ED via TS, then admitted and managed by TNF, have similar outcomes to those seen by in-person neurology follow-up (IPF) after admission. Methods: In our spoke EDs, 4069 IS patients were seen via TS (9/2015-12/2018). Figure 1 demonstrates hospital stroke designations and patient triage patterns. Transfer was at ED discretion. We compared baseline demographics, clinical characteristics, and hospital outcomes in patients with TNF vs IPF. Results: There were 447 (23%) patients with TNF and 1459 (77%) IPF. Both groups presented with similar stroke severity (Table 1). In multivariate analysis, there were no significant differences in discharge disposition, stroke readmission rates, or 90-day mRS; length of stay was shorter with TNF. tPA-only patients showed no differences in outcomes and similar complication rates. TNF patients less likely received tPA or endovascular therapy. TNF resulted in a 3% transfer rate for higher level of care. There remained no difference in outcomes in a sub-analysis without CSCs. A higher proportion of non-Hispanic Black patients and lower proportion of Hispanic patients in the TNF group were possibly due to spoke demographics. Conclusion: TNF resulted in comparable outcomes to IPF and few transfers after admission. For select IS patients, TNF provides an alternative to transfer for hospitals lacking neurology coverage.