Abstract
Background: Door to telestroke request times (DTSR) contribute to door to needle time (DTN) in telestroke networks, however, data is limited on the relationship between DTSR, DTN and other contributing factors. We aimed to evaluate the relationship between processes at the spoke, by EMS and how these contributed to DTN in telestroke spokes. Methods: This is a multi-center retrospective analysis of telestroke patients treated with IV thrombolysis from a hub and spoke telestroke network from June 2018 to March 2023. Patients were excluded from this study due to missing data. The Primary outcome was to examine the relationship between DTSR, DTN and other contributing variables. Multiple regression analyses evaluated which factors contributed to DTSR and DTN. A simple mediation model with covariates NIHSS and average telestroke volume was used to determine if DTSR mediates the relationship between door to stroke alert and DTN. A subgroup analysis examined which variables contributed to DTSR in patients arriving by EMS. A hierarchical multivariable regression analysis entering potential confounding variables as identified in preliminary analyses then variables of interest was used in the subgroup analysis. Results: There were 582 telestroke patients treated with IV thrombolysis and after exclusions, 471 (80.9%) patients were included in the study. The mean age ± SD of the patients was 69.50 ± 15.11 and 238 (50.5%) were female. Door to telestroke request partially mediated the relationship between door to stroke alert and DTN as door to stroke alert was significantly associated with DTN after adjustment for DTSR, B = 0.25 [95% Confidence Interval (CI), 0.10 - 0.41], p < 0.001. In the adjusted model, DTSR explained 29% [95%CI, 22% - 35%] of the variance in DTN. Prehospital stroke alert by EMS reduced DTSR by 6.99 minutes [95%CI, 3.31 - 10.68], p < 0.001, after adjustment of confounding variables. In patients with prehospital stroke alert, earlier ED physician evaluation was associated with quicker DTSR, B = 0.48 [95%CI, 0.01 - 0.95], p = 0.045. Conclusion: Early notification of the local stroke alert team and telestroke physician is associated with quicker DTN. Prehospital stroke alerts by EMS allow for quicker evaluation by ED physician which results in reduced DTSR.
Published Version
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