Abstract
BackgroundIn acute ischemic stroke patients, telestroke technology provides sustainable approaches to improve the use of thrombolysis therapy. How this is achieved as it relates to inclusion or exclusion of clinical risk factors for thrombolysis is not fully understood. We investigated this in a population of hypertensive stroke patients.MethodsStructured data from a regional stroke registry that contained telestroke and non telestroke patients with a primary diagnosis of acute ischemic stroke with history of hypertension were collected between January 2014 and June 2016. Clinical risk factors associated with inclusion or exclusion for recombinant tissue plasminogen activator (rtPA) in the telestroke and non telestroke were identified using multiple regression analysis. Associations between variables and rtPA in the regression models were determined using variance inflation factors while the fitness of each model was determined using the ROC curve to predict the power of each logistic regression model.ResultsThe non telestroke admitted more patients (62% vs 38%), when compared with the telestroke. Although the telestroke admitted fewer patients, it excluded 11% and administered thrombolysis therapy to 89% of stroke patients with hypertension. In the non telestroke group, adjusted odd ratios showed significant associations of NIH stroke scale score (OR = 1.059, 95% CI, 1.025–1.093, P < 0.001) and coronary artery disease (OR = 2.003, 95% CI, 1.16–3.457, P = 0.013) with inclusion, while increasing age (OR = 0.979, 95% CI, 0.961–0.996, P = 0.017), higher INR (OR = 0.146, 95% CI, 0.032–0.665, P = 0.013), history of previous stroke (OR = 0.39, 95% CI, 0.223–0.68, P = 0.001), and renal insufficiency (OR = 0.153, 95% CI, 0.046–0.508, P = 0.002) were associated with rtPA exclusion. In the telestroke, only direct admission to the telestroke was associated with rtPA administration, (OR = 4.083, 95% CI, 1.322–12.611, P = 0.014).ConclusionThe direct admission of hypertensive stroke patients to the telestroke network was the only factor associated with inclusion for thrombolysis therapy even after adjustment for baseline variables. The telestroke technology provides less restrictive criteria for clinical risk factors associated with the inclusion of hypertensive stroke patients for thrombolysis.
Highlights
In acute ischemic stroke patients, telestroke technology provides sustainable approaches to improve the use of thrombolysis therapy
The results indicate that telestroke as a variable was the strongest predictor of recombinant tissue plasminogen activator (rtPA) administration (OR = 5.204, 95% Confidence interval (CI), 2.582– 10.492, P < 0.001), followed by a direct admission (OR = 4.557, 95% CI, 1.772–11.721, P = 0.002), and higher NIH stroke scale score (OR = 1.046, 95% CI, 1.016–1.076, P = 0.002)
In a population of hypertensive stroke patients, we found patients that present with obesity, who are directly admitted to the hospital, and received rtPA have higher odds of being associated with the telestroke, while those with a higher systolic blood pressure were associated with the non telestroke
Summary
In acute ischemic stroke patients, telestroke technology provides sustainable approaches to improve the use of thrombolysis therapy. How this is achieved as it relates to inclusion or exclusion of clinical risk factors for thrombolysis is not fully understood. The number of patients receiving rtPA increases by almost a factor of ten over previous numbers when telestroke technology is applied [4, 5] This is because telestroke extends the expertise of stroke centers to provide enhanced stroke care, the administration of rtPA to smaller rural and community hospitals [6, 7]. It is faster, employs the most recent technology and promotes a better use of limited resources.
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