Abstract 84: The EQUITe Telestroke Study

Abstract

Background: Telestroke (TS) is well established, yet there is a lack of large-scale, outcomes data on TS effectiveness to improve acute treatment in rural systems of care. Specialist On Call © is the largest national provider of tele-emergency consults, with > 23,000 consults/yr.; 61% are acute stroke consults. Funded by a HRSA grant, we evaluated effectiveness of TS programs to improve access and timeliness of tPA treatment n the UVA Telestroke and SOC tele network of rural hospitals. Methods: Phase I: Rural hospitals were defined by OMB standards. Aggregated SOC data were pooled from 46 hospitals 2012-15; (4,462 consults). 73% of patient encounters (3,247) were t ischemic strokes (AIS); 19% (578) were tPA treated. Data were analyzed for demographics, NIHSS score, % patients treated tPA < 60 min, and % treated within 3 hrs. of LSN. Phase II: An online CEU/CME telestroke-presenter training program was designed to teach emergency staff clinical/technical skills to facilitate TS encounters. www.startelehealth.org/. Results: 53% of AIS patients were ≥ 65 yo; 47% ≤ 65 yo. In AIS patients, NIHSS was 0-8 in 79%, 9-15 in 11%, and 16-40 in 9.6%. For tPA treated patients, NIHSS was 0-8 in 53%, 9-15 in 23 % and 16-40 in 25%. A total of 73.2% of tPA patients were treated 180 min from LSN. 16.8% of AIS patients received tPA within 4.5 hrs of LSN. DTN median time was 83 min. 22% received tPA ≤ 60 min DTN. Patient arrival to SOC call initiated was 44 min (median). Call to video consult was 20min for both AIS and tPA patients. Phase II: Stroke protocol packets are being piloted in rural TS hospitals, and online telepresenter training has been launched (in progress). Conclusions: This is the largest outcomes study of acute TS encounters in rural US hospitals. Treatment in AIS with tPA was high (19%) indicating increased access to acute tele-neurological expertise. Teleconsultation physician response time was rapid, while patient arrival to SOC call time was much longer. Work is needed to ensure better adherence to DTN < 60min in rural hospitals consistent with AHA-ASA GL. In Phase II, we will determine impact of TS education programs to improve timeliness of treatment (stroke-specific tele-presenter training & triage protocols) in comparison to control.

A Teleradiology System for Early Ischemic and Hemorrhagic Stroke Evaluation and Management

“…American Heart Association/American Stroke Association stroke has also released guidelines which strongly support Food and Drug Administration-approved teleradiology services for acute stroke care. 25 The Government of India has also made an initiative in 2010 through the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke as part of National Health Mission, the Union Ministry of Health & Family Welfare for the early diagnosis, management, public awareness, infrastructure, and capacity building for noncommunicable diseases including stroke at different levels of health care system. 26 A dedicated international teleradiology stroke network designed in our study allowed the interpretation and analysis of the CT scans of the stroke patient from a distant hospital in United States by a teleradiologist via high-quality DICOM-image transfer through a cloud-based platform.…”