Teleneurocritical Care for Patients with Large Vessel Occlusive Ischemic Stroke Treated by Thrombectomy

Murray, Nick M; Marshall, Scott; Hoesch, Robert E.; Hobbs, Kyle; Smith, Shawn; Roller, Dean; Thomas, Katherine P.; Meier, Kevin; Puttgen, Adrian

doi:10.1007/s12028-022-01632-x

Cited by 3 publications

(4 citation statements)

References 28 publications

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“…10 Compared to the largest prior study of extended window thrombolysis (WAKE-UP), which noted a sICH rate of 2.0% in the alteplase and .4% in the placebo groups, the sICH rate in our treatment group is comparable. 11 Telestroke extended-window treated patient outcomes were favorable, with all patients achieving a discharge mRS of three or less, similar to that of patients treated by in-person by the same group of neurologists. Prior study of extended window thrombolysis by MRI criteria reported mRS scores at 90 days, with the primarily outcome of a mRS of 0-1 which was achieved by 53.3% of the IV alteplase group and in 41.8% of the placebo group (P = .02).…”

Section: Discussionmentioning

confidence: 61%

“…12 Prior study of Teleneurocritical care using this system demonstrated favorable care equivalency to inperson providers. 11 This study has several limitations. First, the telestroke cohort is small and thus limits statistical power, comparisons, and generalizability.…”

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

“…12 Prior study of Teleneurocritical care using this system demonstrated favorable care equivalency to in-person providers. 11…”

Section: Discussionmentioning

confidence: 99%

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Extended Window Thrombolytics for Ischemic Stroke: A Telestroke versus In-person Experience

Murray,

Johnson,

McKasson

et al. 2023

The Neurohospitalist

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Background and Purpose Telestroke evaluation of patients with acute ischemic stroke is supported by American Heart and Stroke Association Guidelines. However, there is no data on outcomes or safety of administering IV thrombolytic stroke therapy using extended window criteria (>4.5 h since onset of symptoms with a hyperacute MRI diffusion T2/FLAIR mismatch) via telestroke. Here, we report adverse events and outcomes of extended-window thrombolysis by telestroke vs in-person care. Methods We performed a retrospective cohort review from 2020 to 2022 of prospectively collected multinstitutional databases from a large, not-for-profit health system with both in-person stroke and telestroke care. The primary outcome was frequency of symptomatic intracranial hemorrhage (sICH). Secondary outcomes were favorable functional outcome at hospital discharge (modified Rankin Scale, mRS, 0-3) and discharge disposition. Results A total of 33 patients were treated with extended-window thrombolysis (n = 20 in-person, n = 13 telestroke). The median NIH stroke scale was 6, and time since last known normal was similar (median [95% CI]: in-person 13 h [11-15 h] vs telestroke 12 h [9-16 h], P = .33). The sICH frequency was low and occurred in one patient (4.8% in-person vs 0% by telestroke). Favorable outcome at discharge was not different between in-person and telestroke care (median mRS [95% CI]: 2 [1-3] vs 1 [0-2], OR .0 [.0-1.8], P = .27), and discharge deposition was also similar. Conclusions In patients eligible for extended window acute stroke treatment with thrombolytics, there was no difference in adverse events between telestroke and in-person care.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

“…12 Prior study of Teleneurocritical care using this system demonstrated favorable care equivalency to in-person providers. 11…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Extended Window Thrombolytics for Ischemic Stroke: A Telestroke versus In-person Experience

Murray,

Johnson,

McKasson

et al. 2023

The Neurohospitalist

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Poisson Modeling Predicts Acute Telestroke Patient Call Volume

Duren,

Puttgen,

Martinez

et al. 2024

Telemedicine and e-Health

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Teleneurocritical care is associated with equivalent billable charges to in-person neurocritical care for patients with acute stroke

et al. 2023

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Introduction Teleneurocritical care (TNCC) provides virtual care for hospitals who do not have continuous neurointensivist coverage. It is not known if TNCC is cost effective nor which variables impact the total billed charges per patient encounter. We characterize cost, defined by charge characteristics of TNCC compared to in-person neurocritical care (NCC), for patients with acute ischemic or hemorrhagic stroke requiring ICU care. Methods We performed a retrospective review from 2018 to 2021 of prospectively collected multinstitutional databases from a large, integrated, not-for-profit health system with an in-person NCC and spoke TNCC sites. The primary outcome was the total billable charge per TNCC patient with acute ischemic or hemorrhagic stroke compared to in-person NCC. Secondary outcomes were functional outcome, transfer rate, and length of stay (LOS). Results A total of 1779 patients met inclusion criteria, 1062 at the hub in-person NCC hospital and 717 at spoke TNCC hospitals. Total billed patient charges of TNCC were similar to in-person NCC (median 104% of the cost per in-person NCC patient, 95% CI: 99%–108%). From 2018 to 2021, the charge difference between TNCC and NCC was not different ( r2 = 0.71, p = 0.16). Both age and length stay were independently predictive of charges: for every year older the charge increased by US $6.3, and every day greater LOS the charge increased by $2084.3 ( p < 0.001, both). TNCC transfer rates were low, and TNCC had shorter LOS and greater favorable functional outcome. Discussion TNCC was associated with similar patient financial charges as compared to in-person NCC. Standardization of care and the integrated hub-spoke value-focused operational procedures of TNCC may be applicable to other healthcare systems, however, further prospective study is needed.

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Teleneurocritical Care for Patients with Large Vessel Occlusive Ischemic Stroke Treated by Thrombectomy

Cited by 3 publications

References 28 publications

Extended Window Thrombolytics for Ischemic Stroke: A Telestroke versus In-person Experience

Extended Window Thrombolytics for Ischemic Stroke: A Telestroke versus In-person Experience

Poisson Modeling Predicts Acute Telestroke Patient Call Volume

Teleneurocritical care is associated with equivalent billable charges to in-person neurocritical care for patients with acute stroke

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