Abstract WP295: Feasibility and Safety of a Large-Scale Teleneurology Network for the Treatment of Acute Stroke in a Heterogeneous Multihospital Patient Population

Abstract

Background: Administration of alteplase is the standard of care for eligible patients presenting with symptoms of acute ischemic stroke (AIS). Telemedicine is increasingly being used to deliver acute stroke care to patients without in-person access to stroke expertise. This study reviews the alteplase experience and outcomes of the largest known teleneurology network spanning 34 states and distributed across a heterogeneous multihospital population. Methods: Data was abstracted from internal medical records systems and relevant medical records obtained from partner hospitals. A retrospective analysis on the prospectively maintained database of patients who have received alteplase was performed. Data was collected from December 1, 2015 to June 30, 2018. Outcome analysis was restricted to those patients with available complete discharge data. Collected data included demographics, stroke severity, symptomatic intracranial hemorrhages (sICH), discharge disposition and mortality. Results: The analysis revealed 6199 patients as having received alteplase during the study period. Of these, 56.7% had discharge information available. The mean patient age was 69.7 years, with a mean age of 71.8 years for females and 67.4 for males. The median initial NIHSS was 7, with 30.3% of patients presenting with NIHSS ≤4 and 8.5% initially presenting with initial NIHSS ≥21. Only 19.7% of patients were transferred to another facility. Clinical outcomes data were available for 3327 patients (53.7%). There were 1536 home discharges (46.2%), 626 acute rehabilitation discharges (18.8%), and 283 skilled nursing facility discharges (8.5%). The sICH rate in this population was 0.9% (29) and there were 136 patient deaths (4.1%). Conclusion: Large-scale teleneurology for the treatment of patients presenting with symptoms of AIS is feasible, with clinical outcome data similar to other published studies. Further refinement of this data, to include subgroup analyses, transfer patterns, and more comprehensive clinical outcomes is warranted.