The impact of teleneurologists on acute stroke care at an advanced primary stroke centre

Abstract

Introduction We evaluated the impact of tele-neurologists on the time to initiating acute stroke care versus traditional bedside neurologists at an advanced stroke center. Methods This observational study evaluated time to treatment for acute stroke patients at a single hospital, certified as an advanced primary stroke centre, with thrombectomy capabilities. Consecutive stroke alert patients between 1 March, 2016 and 31 March, 2018 were divided into two groups based on their neurology consultation service (bedside neurology: 1 March, 2016–28 February, 2017; tele-neurology: 1 April, 2017–31 March, 2018). Door-to-tPA time and door-to-IR time for mechanical thrombectomy were compared between the two groups. Results Nine hundred and fifty-nine stroke patients met the inclusion criteria (436 bedside neurology, 523 tele-neurology patients). There were no significant differences in sex, age, or stroke final diagnosis between groups ( p > 0.05). 85 bedside neurology patients received tPA and 35 had mechanical thrombectomy, 84 and 44 for the tele-neurology group respectively. Door-to-tPA time (median (IQR)) was significantly higher among tele-neurology (64 min (51.5–83.5)) than bedside neurology patients (45 min (34–69); p < 0.0001). There was no difference in door-to-IR times (mean ± SD) between bedside neurology (87.2 ± 33.3 min) and tele-neurology (90.4 ± 33.4 min; p = 0.67). Discussion At this facility, our tele-neurology services vendor was associated with a statistically significant delay in tPA administration compared with bedside neurologists. There was no difference in door-to-IR times. Delays in tPA administration make it harder to meet acute stroke care guidelines and could worsen patient outcomes.

“But it's a nice compromise” – Qualitative multi‐centre study of barriers and facilitators to acute telestroke cooperation in a regional stroke network

“…Most high-income countries operate health systems which ensure that stroke units can be reached on time within a defined geographical area. As this requires a 24 h/7 d availability of specialized staff, more remote locations (spokes) may opt to integrate their stroke unit within the on-site internal medicine department and receive teleservices from neurologists located at specialized hospitals (hub) [9][10][11][12][13][14][15]. In Germany, there are currently 22 active networks with different models of telestroke provision, including 24 h/7 d or partial coverage during night and weekend shifts, networks with one or several hubs or teleneurological and teleneuroradiological services provided by the same or different hubs [9,16].…”

Effect of telestroke practices on short-term mortality in ischemic stroke patients

“…Gutowitz et al compared teleneurology and non-teleneurology groups in terms of rtPA and thrombectomy treatments and determined no significant difference. [16] In a multicenter, cross-sectional study, including 29 hospitals, that examined a two-year telestroke period, the rate of rtPA treatment was higher in the hospital where telestroke was used than in other hospitals. [18] The results of our study revealed that the rates of both rtPA and thrombectomy treatments were significantly higher in the group in which the telestroke system was used compared to the pre-telestroke group (p<0.001).…”

“…[2,12] In another study in which 959 stroke patients-of whom 523 were teleneurology patients-were retrospectively examined, the door-to-rtPA time was significantly shorter in the telestroke group, but there was no statistically significant difference between the groups in terms of the door-tothrombectomy time. [16] In another study, the effectiveness of the pre-hospital telestroke system was investigated with 650 patients that were transferred to the hospital without telestroke and 289 transferred to the hospital using telestroke, and no statistically significant difference was found between the two groups in relation to thrombolytic treatment. [17] In our study, we observed that the door-to-thrombectomy/min time was longer in the telestroke group compared to the pre-telestroke group (p<0.001), and the door-to-rtPA time was 7 lower in the telestroke group, but without statistical significance (p=0.627).…”