Outcomes following telestroke-assisted thrombolysis for stroke in Ontario, Canada

Abstract

Introduction Since 2002, the Ontario Telestroke Program has provided hospitals in under-served regions of the province the opportunity to offer intravenous thrombolysis with tissue plasminogen activator (IV tPA) to eligible patients. The purpose of this study was to determine whether telestroke-assisted IV tPA patients had similar risks of 7- and 90-day mortality, symptomatic intracerebral haemorrhage (sICH), and poor functional outcome compared to patients who received IV tPA with on-site expertise. Methods Data from two audits of patients with acute ischaemic stroke hospitalized in Ontario, Canada in 2010 and 2012 were analysed. We modelled the risk of all-cause death within 7 and 90 days of receiving IV tPA using proportional hazards adjusting for hospital type, patient characteristics, and whether IV tPA was administered as part of a telestroke consultation. Outcomes of sICH and modified Rankin Scale ≥ 3 at discharge were modelled using generalized estimating equations adjusting for the same variables used in the mortality model. Results There was no difference in 7- or 90-day mortality among those who received IV tPA with telestroke ( n = 214) compared to those without ( n = 1885) (7-day adjusted hazard ratio (aHR) 1.29 (95% confidence interval (CI) 0.68, 2.44); 90-day aHR 1.01 (95% CI 0.67, 1.50)). Complications were similar between groups, with an adjusted odds ratio (aOR) for sICH of 0.71 (95% CI 0.29, 1.71) and an aOR of 0.75 (95% CI 0.46, 1.23) for poor functional ability at discharge. Discussion Patients receiving IV tPA supported by telestroke had similar outcomes to those managed with on-site expertise.

Improving acute stroke care in regional hospitals: clinical evaluation of the Victorian Stroke Telemedicine program

“…Functional outcomes were similar whether the patient was treated in a stroke telemedicine hospital (spoke) or in a stroke centre hospital (hub) . Similar findings have been reported in the US and Canada . In a meta‐analysis of 26 studies (6605 patients receiving thrombolysis), no significant differences were found between stroke telemedicine and control groups in terms of in‐hospital mortality, 90‐day mortality, symptomatic intracranial haemorrhage, and clinical outcome at discharge or at 90‐day follow‐up …”

Decreased Stroke Presentation Rates at a Comprehensive Stroke Center during COVID-19

“…3 Acute stroke care at remote hospitals throughout the province of Ontario (population 14 million) is supported by the Ontario telestroke program (OTP). 4 Currently, there are 31 hospitals that refer to the OTP, including designated district stroke centers (primary stroke centers) and nondesignated hospitals that provide thrombolytic therapy. Emergency physicians at these referring hospitals request a telestroke consultation by calling CritiCall, a provincial program that supports access to emergent care.…”

Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort

“…15,16 Over the past decade, telemedicine-guided acute ischaemic stroke care has been shown to be accurate and safe and to produce comparable favourable clinical outcomes compared to traditional on-site care. 17–22 There is also growing evidence that telemedicine is effective in improving the rate and timeliness of tPA administration. 23–26…”

“…While telemedicine models have been broadly used in ED stroke care, most prior studies have been limited in scope to a single network. 15,17–26 In order to characterise the overall impact of telemedicine better, we studied emergency stroke care in four telemedicine networks. The objectives of this study were to (a) identify the overall impact of telemedicine on ED stroke care measures of time to interpret a computed tomography (CT) of the head and time to administer tPA, (b) identify if the impact of telemedicine varied by network and (c) describe the variation in these process outcomes by telemedicine across EDs.…”