Abstract WP367: Comparison of Standard Emergency Room Care with Tele-Stroke Evaluation in Acute Intracerebral Hemorrhage Management

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Abstract

Introduction: Intracerebral hemorrhage (ICH) management includes rapid blood pressure (BP) control and correction of any coagulopathy. It is unknown if the addition of tele-medicine (TM) assessment by vascular neurologists would improve time to intervention of these factors. We hypothesized that TM assessment would improve the time to BP control and anticoagulation reversal compared to standard emergency physician management with telephone neurosurgical consultation (ED).

Methods: Charts were retrospectively reviewed for all patients with a primary ICD-9 diagnosis of ICH who presented directly to the ED between 8/15/2013 and 5/30/2015, in three urban primary stroke centers in a Southern California integrated healthcare system that utilizes a internalized tele-stroke system. Patients who were transferred from outside hospitals were excluded. Data collected were patient demographics and specific time points to assess door to BP reduction and anticoagulant reversal initiation. These were compared for patients evaluated by ED vs TM using Fisher’s exact test, Chi-squared test, and Wilcoxon test.

Results: Data for 105 ED and 19 TM patients were compared. There was no difference in gender (54.8% male), median age (67 yrs {IQR 58.5-80 yrs}), and median presenting BP (180/93 {IQR 157-207/79.5-108}). Patients seen by TM had a significantly shorter median time from onset to presentation (102.5 min {IQR 37-191 min}) compared to patients evaluated by ED (171 min {IQR 60-492 min}). Patients seen by TM were more likely to have NIHSS documented, faster times to CT head completion and interpretation, higher rates of BP agent administration with faster times to BP agent order and administration, faster time to BP control (both less than systolic 160 and 140), and faster times for anticoagulation reversal order and administration.

Conclusion: TM assessment of patients with ICH improves time to BP control and anticoagulation reversal agent initiation.

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