Abstract WP89: A Functional Outcome Model for a Telestroke-guided Tissue Plasminogen Activator Treatment of Stroke Patients

Abstract

Background: The success of telestroke systems as a means to extend stroke-care expertise into rural and underserved areas has been reported. Evidence of clinical outcomes associated with the use of tissue-type plasminogen activator (rtPA) in community hospitals has been documented, but evidence of functional outcome studies in telestroke-guided rtPA treatment are lacking. This issue was investigated in this study. Methods: Data from a stroke registry of 307 acute ischemic patients treated with intravenous rtPA in a telestroke network was analyzed. A new functional outcome model was developed to asses rtPA treatment outcome using a combination of visual basic and multivariate logistic models. Differences in functional outcomes between patients that received rtPA and those did not receive rtPA were determined. A partial proportional-odds model was developed for common odd ratio based on cumulative logits for all functional outcome variables. The significance level of all analysis was set to a probability level of p<0.05. Results: In a telestroke-guided rtPA treatment of stroke patients, age was significantly (P<0.0001, OR 0.902) associated with improved functional outcome. Stroke patients with a medical history of obesity (P=0.002, OR 4.016), and a previous history of stroke (P=0.024, OR 2.765) were associated with improved functional outcomes. The odd of an improved functional outcome was higher for stroke patients with systolic blood pressure (P=0.012, OR 3.135) as the initial vital sign. Moreover, patients with initial lower NIH stroke scale scores (P<0.001, OR 0.911) were associated with improved functional outcome. Conclusion: Modified Rankin Scale distribution and other measures have been used to measure clinical outcomes in rtPA-treated patients. The development of a new functional outcome model provides a new approach to improve the efficiency of the telestroke and increase of rtPA for stroke patients.