Abstract WMP91: The Mortality Rate Of Stroke Patients Is Less When Treated At Telestroke Spokes Vs. Non Telestroke Sites
Background: Most rural hospitals in Arkansas did not administer t-PA prior to participating in a telestroke program. With the growing number of telestroke networks, it is crucial to determine the effectiveness of these programs in improving the outcome of ischemic stroke patients.
Methods: The Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) team reviewed the hospital discharge data of AR SAVES hospitals versus propensity score matched control hospitals linked with death certificates from 2006 to 2010 provided by the Arkansas Department of Health. All patients with primary ICD-9 codes for ischemic stroke were included. Hospitals with less than 10 admissions for ischemic stroke during the study period were excluded. ARSAVES hospitals were included in the evaluation if they started participating in the first 12 months of program initiation. All hospitals in the state that were not in the ARSAVES program prior to Jan 1, 2011 were the control group. Analyses were done using chi-square tests and t-tests. We used multivariable logistic regression models to compare differences in dichotomous outcomes.
Results: A total of 18 hospitals and 3,728 ischemic stroke patients were included in the final analysis. Patients treated in participating hospitals had reduced mortality rates at 30 days (ARR 0.58, 95% CI 0.40-0.85), 6 months (ARR 0.57, 95% CI 0.42-0.77) and 12 months (ARR 0.66, 95% CI 0.48-0.90), as well as reduced rates of discharge to hospice care (ARR 0.53, 95% CI 0.29-0.99). There were no statistically significant differences in either length of hospital stay (AME 0.35 days, 95% CI -0.31 to 1.01) or hospital cost (AME $629, 95% CI -834 to 2,091).
Conclusion: Stroke patients treated at telestroke spoke hospitals had a significantly lower mortality rate than those treated at a non telestroke hospital, with the same cost of care. This may be a reflection of increased t-PA use and improved stroke education and stroke patient care in telestroke hospitals.
- © 2012 by American Heart Association, Inc.