Acute ischemic stroke and thrombolysis location: comparing telemedicine and stroke center treatment outcomes.
BACKGROUND
Telemedicine has been increasingly used as an option for acute ischemic stroke treatment at hospitals where neurological expertise is not available. The aim of this study was to compare the outcome of stroke patients treated with systemic thrombolysis at our academic hub regional stroke centers (hub) versus our spoke hospital telemedicine locations (spoke)


METHODS
Data were retrospectively reviewed for consecutive patients admitted for stroke treatment with intravenous tissue plasminogen activator at our hub (128 patients) and at the spoke centers (27 patients) over a 2-year period. Mortality was selected as a primary outcome measure, and post-thrombolysis intracranial hemorrhage (PT-ICH) rate, hospital length of stay (LOS), and discharge modified Rankin Scale (mRS) score were selected as secondary outcome measures. Logistic regression models were used to determine the effect of thrombolysis treatment site on stroke outcomes.


RESULTS
Demographic and clinical variables of patients treated at the hub versus spoke sites were similar, except for a lower initial platelet count and a shorter time from ictus onset to needle in the spoke group. With covariates, the treatment site (hub vs spoke) did not have a significant impact on mortality (10.9% vs 11.1%; P = 0.34), nor on PT-ICH (20.3% vs 33.3%; P < 0.35). Site did not reach significance in affecting discharge outcome: 52.3% versus 51.9% of patients had good outcomes (mRS 0-3) and 47.7% versus 48.1% patients had poor outcomes (mRS, 4-6; P = 0.16). Length of stay was also not significantly affected by site: 8.8 days versus 10.7 days (P < 0.23).


CONCLUSIONS
The hub-and-spoke telemedicine model for acute ischemic stroke treatment seems to carry similar efficacy and safety outcomes at the regional academic hub and spoke centers.
Ionita
Catalina C
CC
University at Buffalo Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, 3 Buffalo, NY 14209, USA. ccionita@buffalo.edu
Sharma
Jitendra
J
Janicke
David M
DM
Levy
Elad I
EI
Siddiqui
Adnan H
AH
Agrawal
Sachin
S
Baker
John G
JG
Agopian
Eliz
E
Olson
Karen
K
Hopkins
L Nelson
LN
D000208:Acute Disease; D002545:Brain Ischemia / Q000188:drug therapy* / Q000451:nursing; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D011785:Quality Assurance, Health Care; D019114:Remote Consultation / Q000379:methods*; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000451:nursing; D017216:Telemedicine / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator