Abstract WP72: Why Are Acute Ischemic Stroke Patients Not Receiving IV tPA in Telestroke Network

Abstract

Background: Reasons for non-lysis treatment are explored as telestroke networks have become more common. Telemedicine is increasingly becoming the first contact for evaluation and treatment of AIS patients. Objective: Determine reasons for not giving intravenous (IV) Activase to eligible patients with acute ischemic stroke (AIS). Methods: We performed a retrospective analysis of prospectively collected data of non-lytic patients who were seen as a telestroke consultation with Arkansas Stroke Assistance through Virtual Emergency Support ( AR SAVES ) for possible AIS for year 2015. Results: A total of 809 total patients who met criteria for telemedicine consults received neurology examination. A total of 238 patients received IV Activase treatment. Of the remaining 571 non-treated patients (no thrombolytics), 305 were thought to be AIS based on clinical evaluation. Of these patients data was available for 276. The most common reason non-treatment was: 1) minimal deficits at 44% (n=124), 2) falling out of the 4.5 hour time window 27% (n=76) and 3) next of kin refusal in 19% (n=53). Other less common causes for non-treatment were; 4) abnormal labs (n=15), 5) recent surgery (n=4), 6) neoplasms (n=2) and 7) determination of hemorrhagic stroke (n=2). Minimal deficits or rapidly improving symptoms was the most common reason for not being treated with IV Activase in our telestroke program. The 27% who fell out of the treatment sphere were due to excess time spent door to CT. The next of kin refusal for treatment at 19% is higher than the 6% reported for traditional practices. Conclusion: Minimal deficits was the most common reason for non-lytic treatment in our telestroke system and other hospitals. Next of kin refusal seems to be significantly higher than reported for traditional practices which are around 6% compared to 19% with our patient population. This might have been secondary to difficulty in explaining the risk vs benefits over a video conference. Other causes should also be explored as telestroke networks have become more common and are increasingly becoming first contact for evaluation and treatment of acute ischemic stroke patients.