Background: Intravenous alteplase (rtPA) is a proven treatment for acute ischemic stroke. The implementation of telestroke networks increases access to expert stroke care and rtPA administration. Previous studies showed that faster door to needle time (DTN) leads to a better functional outcome; however DTN has been shown to be longer over telestroke when compared to that at a comprehensive stroke center. The purpose of this study is to compare the long term functional outcome of rtPA when administered at spoke hospitals through telestroke consultations to that at the comprehensive stroke center (hub).
Methods: Data on baseline characteristics and long-term outcomes for all patients evaluated at the Medical University of South Carolina (MUSC) and MUSC telestroke network between January 2016 and March 2017 were collected. Eligible patients received rtPA at either the spoke or hub location during the study period. Data sources included registry data collected from telestroke consultations at 22 different spokes in South Carolina and electronic medical record data for patients at one hub. Patients who received mechanical thromectomy were excluded from the study. Functional outcome was assessed with 90 day Modified Rankin Scale (mRS). To predict the odds of a low category mRS for spoke patients compared to hub, adjusting for patient stroke severity (NIHSS), door to needle time, age, sex, and race, we estimated a logit model. T-tests and Chi-squared were used to examine the differences in continuous and categorical patient variables.
Results: Total of 426 were identified (60 hub and 366 spoke patients). There were no significant differences in patient age, sex, admission NIHSS, or door to needle times between the two groups. More patients (55%) were white in the hub group compared to (61.8%) in the spoke group (P=0.02). mRS of 0-2 at 90 days was achieved in 37 (61.7%) of the hub and in 255 (69.7%) in the spoke patients (P=0.216). On logistic regression, there was no difference in the adjusted odds of having a lower mRS between spoke and hub patients (OR 1.75, p=0.104, 95% CI [0.89-3.37]).
Conclusion: Our study shows no difference in the long-term functional outcome for rtPA when administered at spokes through telestroke compared to that at the hub.