Abstract 2885: Predictors of Poor Outcome in Moderate to Severe Strokes in a Statewide Telestroke Network
Objective: to determine the predictors of poor outcome after IV thrombolysis for moderate to severe strokes in a statewide telestroke network.
Background: The Arkansas SAVES (Stroke Assistance through Virtual Emergency Support) telestroke network provided emergency evaluation and therapy for acute stroke to 22 spoke sites statewide between November 2008 and May 2011. The spoke hospitals range from large, yet lacking neurologist’s support, to critical access hospitals. Following thrombolysis, patients are cared for at the spoke, or get transferred to one of the hub PSC hospitals. Predictors of poor outcome after IV thrombolysis in a PSC are established. There is no available literature on such predictors in a hub and spoke model of a telestroke network, in which variables such as post thrombolysis care location could impact outcome.
Methods: Institutional IRB approval was obtained to review the prospective database of the Arkansas SAVES program. We included patients with admission NIHSS ≥ 8. They were divided into two groups, based on 90-day outcome, dichotomized into mRS ≤ 2 and mRS > 2. Baseline characteristics, risk factors, time intervals, laboratory data, and post thrombolysis care location (hub vs. spoke) were compared between the two groups. For statistical analysis, we used independent T, and fisher’s exact tests. A multivariate logistic regression analysis was performed.
Results: The cohort included 562 patients receiving a teleconsultation between November 2008 and May 2011, of whom 116 underwent IV thrombolysis. Sixty-seven patients with admission NIHSS ≥ 8 were included in this analysis. Results are depicted in table 1. In multivariate regression analysis (table 2), patients with a 90-day mRS > 2 were more likely to have atrial fibrillation (OR = 6.76, p = 0.038), admission blood sugar > 8 mmol/L (OR = 7.45, p = 0.01), and an admission NIHSS > 12 (OR = 5.12, p = 0.017). Patients with a worse outcome at 90 days were more likely to have received post thrombolysis care at a spoke hospital (OR = 15.63, p = 0.019).
Conclusion: In a hub and spoke model of a telestroke network, patients with moderate to severe strokes may benefit from transferring to a PSC after IV thrombolysis, a variable that could improve their functional outcome. Larger studies to confirm those results are needed.
- © 2012 by American Heart Association, Inc.