Abstract TP279: The Multiple-Encounter Telestroke Patient - A Unique Patient Population

Abstract

Background: Thrombolysis with alteplase is the standard of care for treatment of eligible patients presenting with acute ischemic stroke (AIS). Telestroke physicians must use available information to make timely treatment decisions remotely. Through this practice, an unusual subset of patients presenting multiple times with symptoms of AIS has emerged. This study describes the largest known sample of this multiple-encounter population within a single teleneurology practice spanning 34 states. Methods: A retrospective observational study of the experience of a single teleneurology practice serving over 400 hospitals from July 1, 2015 to August 1, 2018 was performed. The alteplase patient database was queried to identify patients with multiple telestroke encounters (n=56). Demographic and clinical data were abstracted. Results: Within the queried period, 56 patients were identified to have had multiple encounters with the teleneurology practice, 37 males and 19 females. Of these, 29 were seen twice, 10 were seen three times, 8 were seen four times, and 9 had five or more encounters. Four patients received care in multiple states. Alteplase was administered on more than one encounter in 45 patients, with a maximum alteplase administration of 4 times in a single patient. The overall alteplase rate was 54.6% (106 of 194 encounters). The median NIHSS score for patients seen in multiple encounters was 5. Of the 56 patients, 98.2% had stroke risk factors, 42.9% had noncerebrovascular neurological comorbidities, and 42.9% had psychiatric disease history. All patients presented with at least one motor symptom, while 64.3% presented with a sensory symptom, 26.8% presented with aphasia, and 55.4% presented with other neurological symptoms. Conclusions: The observance of multiple teleneurology encounters for patients presenting with AIS symptoms and receiving alteplase at high rates is anecdotal and not yet largely described. History of cerebrovascular disease is a risk factor for recurrent stroke, but the true composition of this patient population is undefined. Given the associated risks and resource utilization involved with alteplase, future study of the characteristics and disease mechanism of this population is warranted.