Abstract WP249: Telestroke Is not Associated with a Longer Door-to-needle Time
Background: Telestroke is a promising avenue for treatment of acute stroke patients when a vascular neurologist is not available for bedside assessment. We provide stroke hospitalist services at a local community hospital Monday-Friday, supplemented by telestroke coverage by the same vascular neurologists on night and weekends. We compared door-to-needle (DTN) times via telestroke vs. at the bedside.
Methods: We reviewed cases of acute ischemic stroke patients who received IV r-tPA treatment and determined whether they were assessed at the bedside vs. telestroke. We collected age, risk factors, symptom onset time, admission NIH stroke scale, DTN time, and discharge disposition. A favorable discharge disposition was considered home or acute rehab. Mann-Whitney U and Fisher’s Exact tests were used when appropriate.
Results: Between April 2011 and May 2012, 39 patients were treated with IV r-tPA, 49% (19/39) at the bedside, and the remainder (20/39, 51%) via telestroke. Table 1 is a comparison of the baseline characteristics. The bedside group was slightly older with a higher incidence of atrial fibrillation, but this difference was not significant. Mean DTN times were not significantly different in the bedside group (mean 76.1±34.9 min) compared with the telestroke group (83.5±29.5 min) (p=0.15). Goal DTN times of <60min were met in 9 (47%) of the bedside group versus 4 (20%) in the telestroke group (p=0.06) Mean symptom onset to treatment time was 150.6±61.2 min in the bedside group, versus 145.9±41.0 min in the telestroke group (p=0.46). 9 patients (47%) in the bedside group had a favorable discharge, compared with 15 (75%) in the telestroke group (p=0.21).
Conclusion: In a community hospital, there was no significant difference between door-to-needle times in patients treated with IV r-tPA at the bedside versus via telestroke. This supports the use of telestroke to provide extended coverage to hospitals.
- © 2012 by American Heart Association, Inc.