Abstract WP45: Multiply-Encountered And Multiply-Thrombolysed Telestroke Patients - A Unique Patient Population

Abstract

Background: Many hospitals utilize telestroke services for the remote diagnosis and treatment of acute stroke. Through this practice, an unusual subset of patients with multiple presentations having received thrombolysis numerous times has emerged. This study describes the largest known sample of this multiple encounter population within a single teleneurology practice spanning 39 states over 7 years. Methods: A retrospective observational study of the experience of a single teleneurology practice serving over 400 hospitals from July 2014 to July 2021 was performed. The patient database was queried to identify patients with multiple thrombolysis encounters. Clinical data was abstracted and compared to a random sample of matched singly-thrombolysed case controls. Results: A total of 181 patients received thrombolysis more than once, with 165 having received thrombolysis twice and 16 having received thrombolysis three or more times. Nine patients received care in multiple states. The maximum number of encounters was 25. The multiply-thrombolysed group were more likely to be male than the singly-thrombolysed (84.0% vs 45.3%, P<0.0001). The multiply-thrombolysed group was younger (58.8±15.2 vs 62.8±17.5, P=0.02) and had higher initial NIHSS (6.5±4.3 vs 3.2±5.8, P<0.0001). The multiply-thrombolysed group had lower rates of gaze deviation, dysarthria, extinction, facial droop, abnormal LOC answers. The multiply-thrombolysed group had lower rates of antiplatelet use (21.0% vs 53.5%, P<0.0001). TLSW-to-door time was shorter in the multiply-thrombolysed group (84.6 vs 182.7 minutes, P<0.01). There were no differences in door-to-consult or door-to-needle times between the groups, but the consult length was longer in the multiply-thrombolysed group (61.8 vs 46.4 min, P<0.01). The thrombolysis rate in the multiply-thrombolysed group was 46.7%. Conclusion: The observed phenomena of recurrent telestroke encounters with repeated thrombolysis administration is not well-described nor understood. Given the inherent risk and resource utilization associated with thrombolysis, further analysis including outcomes of this patient population is warranted.