Abstract 2886: Time To Thrombolysis: Does It Make A Difference In Outcome In A Statewide Telestroke Network?
Objective: to determine whether IV thrombolysis 0-3 hours vs. 3-4.5 hours in a statewide telestroke network result in a difference in outcome.
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 to critical access hospitals. Following thrombolysis, patients are cared for at the spoke, or get transferred to one of the hub PSC hospitals. Outcome following IV thrombolysis depends largely on severity of the stroke, and door to needle time, but also on post-thrombolysis care. There is no current data on outcome depending on time window to thrombolysis in a telestroke network.
Methods: Institutional IRB approval was obtained to review the prospective database of the Arkansas SAVES program. We included all patients who received IV thrombolysis. We divided them into two groups, based on time window to thrombolysis (0-3 hours vs. 3-4.5 hours). Baseline characteristics, time intervals, laboratory data, and post thrombolysis care location (hub vs. spoke) were compared between the groups. For statistical analysis, we used independent T, and fisher’s exact tests. A multivariate 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 and were included in this analysis. Patients who received IV thrombolysis 3-4.5 hours were more likely to be males (OR = 2.64, p = 0.028), younger than 70 years (OR = 2.33, p = 0.047), and to have door to needle time > 90 minutes (OR = 2.22, p = 0.062). Their mean time (minutes) to presentation was significantly longer (45.7 ± 24.0 vs. 105.5 ± 47.5, p < 0.0001). The outcome at 90 days and rate of intracerebral hemorrhage was similar between the groups.
Conclusion: In a hub and spoke model of a telestroke network, there is no difference in outcome between patients receiving IV thrombolysis 0-3 hours vs. 3-4.5 hours. A longer time to thrombolysis was caused not only by a delay in patients’ presentation, but also by a longer door to needle time, offering an opportunity for improvement in efficiency of those involved in the teleconsultation process.
- © 2012 by American Heart Association, Inc.