Background: Stroke outcomes have been shown to be worse for patients presenting overnight and on weekends (off-hours) to stroke centers compared with those presenting during business hours (on-hours). Not all stroke patients present to stroke centers. Telemedicine (TM) helps provide evaluation and safe management of stroke patients. The UT Teleneurology (UTT) hub provides acute neurological coverage by stroke specialists to 19 spoke centers. To our knowledge, variation in patient care and outcomes based on time of hospital presentation has not been thoroughly studied in stroke patients managed via TM.
Objective: Compare time metrics and outcomes of stroke patients who were assessed and received IV-tPA via TM during off-hours with those during on-hours.
Methods: In a retrospective query of the UTT registry from 9/15 - 12/16, we identified 425 stroke patients who were assessed via TM and received IV-tPA - 424 were included in our analysis, one was excluded after quality check. We compared baseline characteristics, clinical variables, time metrics, and outcomes between the off-hours (5pm-7:59am, weekends) and on-hours (weekdays 8am-4:59pm) patients (Table 1).
Result: Of the 424 patients, 268 were managed via TM during off-hours, and 156 during on-hours. Baseline characteristics and clinical variables were similar between the groups. Importantly, there were no differences in all relevant time metrics including door to needle time. IV-tPA complications (including all ICH, any systemic bleeding, and angioedema), discharge disposition, and 90-day mRS were also similar in the groups.
Conclusion: There was no difference in clinical outcomes between the patients treated off-hours vs on-hours. Unlike in-person neurology coverage at many centers, the coverage provided by UTT does not differ depending on the hour or day. Access to stroke specialists 24/7 via TM can ensure uniform and rapid clinical care for acute stroke patients regardless of the time of day or day of the week.