Background: The administration of intravenous thrombolysis (IVT) to stroke patients via telestroke (TS) can be safe and effective. It remains unclear how quickly IVT occurs during TS evaluations. We sought to compare door to needle times (DNT) between patients receiving IVT who present directly to our comprehensive stroke center (CSC) and those presenting to community hospitals in our TS network.
Methods: Consecutive acute ischemic stroke (AIS) patients who presented to emergency departments and received IVT between August 2014 and June 2015 were identified at our CSC and TS network. Median DNTs with interquartile ranges (IQR) were calculated in each cohort. Outcomes measured included rates of symptomatic intracerebral hemorrhage, in-hospital mortality, and discharge to home or an acute rehabilitation unit (ARU).
Results: During the study period, 117 AIS patients (mean age 71±15 years, 47% women) receiving IVT were included in the analysis (65 CSC, 52 TS). Median DNT at our CSC was significantly shorter compared to TS DNT (CSC 43 [IQR 35,55] minutes vs TS 54 [IQR 41,71.25] minutes, p=0.005). The proportion of patients receiving IVT within 60 minutes of presentation was significantly higher at our CSC compared to our TS network (CSC 84.6% vs TS 63.5%, p=0.01). Favorable discharge to home or ARU was similar (CSC 76.9% vs TS 75%, p=0.83).
Conclusion: Guideline-recommended DNTs ≤60 minutes can be achieved in community hospitals with TS guidance. Initiatives are required to better resemble DNTs found at stroke centers.