Abstract WP298: Feasibility of a Large-Scale Teleneurology Network for Thrombolysis Administration in a Heterogeneous Multihospital 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 thrombolysis experience of the largest known teleneurology network spanning 39 states and distributed across a heterogeneous multihospital population throughout the nation. 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 May 31, 2019. Outcome analysis was restricted to those patients with available complete discharge data. Results: The analysis revealed 8,399 patients as having received alteplase during the study period. Of these, 56.7% had discharge information available. The mean patient age was 68.5 years, with a mean age of 70.5 years for females and 66.5 years for males. The median initial NIHSS score was 7, with 31.2% of patients presenting with an initial NIHSS score ≤4, and 8.7% presenting with an initial NIHSS score ≥21. The transfer rate to another facility was 31.0%. There were 2,417 home discharges (48.2%), 1,057 acute rehabilitation discharges (21.1%), and 478 skilled nursing facility discharges (9.5%). There were 28 patients who left against medical advice (0.6%). The symptomatic hemorrhage rate in this population was 1.1% (92), and there were 234 patient deaths (4.7%). Conclusion: A large-scale teleneurology platform for the emergent treatment of patients presenting with AIS symptoms is both safe and feasible. Due to the heterogeneity of this patient and hospital population, higher level refinement of this analysis to include hyperacute metrics, transfer data, and more comprehensive clinical and functional outcomes is warranted.