Epidemiology of a large telestroke cohort in the Delaware valley

• Telestroke network has been shown to increase the frequency of tPA usage.
• Telestroke network could help decrease the need for transfer.
• A decrease in transfer rate may result in economical benefit for the network.
• NIHSS and tPA administration at onset predicted transfer.
• It is necessary to increase the public awareness regarding stroke symptoms.

BackgroundThe American Heart Association/American Stroke Association has recently endorsed telestroke. Telestroke has enhanced stroke diagnosis, increased tPA administration and improved long-term outcomes. However, many of the publication on telemedicine so far have been review articles.ObjectivesWe investigated the epidemiological features of telestroke patients and evaluated the difference between the transferred and non-transferred cohorts.MethodsWe collected data on telestroke consultation, between January 2012 and June 2013, regarding patient's age, gender, diagnosis, NIHSS, onset-to-spoke time (OTS), tPA administration and transfer status. Further data was obtained on transferred patients regarding discharge and endovascular interventions.ResultsThe means of age, NIHSS and OTS time were the following: 67.59 years, 7.65 and 11.28 h respectively. The proportion of transferred patients was 12.04% (280/2324); lower than what was previously reported. The overall rate of IV tPA administration was 11.98%. Transferred patients had a significantly higher NIHSS mean (10.93 vs. 6.73; P < 0.001), and were more likely to have received IV-tPA at onset (25.57 vs. 9.67; P < 0.001). The age, gender proportion, stroke mimic proportion, and the mean of OTS did not differ between the two-groups (0.49 vs. 0.31; P = 0.38). A logistic regression showed that NIHSS (OR = 1.06, P < 0.001) and tPA administration at onset (OR = 2.78, P < 0.001) predict the transfer. Of the transferred patients, 4.5% received endovascular intervention. The mortality rate of transferred patients was 12.9%. Other outcomes were the following: 52% discharge to rehabilitation facilities, 29% discharge to home, and 8% discharge to long-term nursing facilities.ConclusionTelestroke network is increasing the frequency of tPA usage in acute ischemic stroke and may decrease the need for transfer. Our aim was to optimize the stroke therapy to shorten the hospital stay and to increase the discharge home. This allows a better functional outcome and an additional benefit of cost-saving for the hospitals.