title: Epidemiology of a large telestroke cohort in the Delaware valley.
abstract: BACKGROUND
  The American Heart Association/American Stroke Association has recently endorsed telestroke. Telestroke has enhanced stroke diagnosis, increased tPA administration and improved long-term outcomes. However, many of the publication on telemedicine so far have been review articles.
  
  
  OBJECTIVE
  We investigated the epidemiological features of telestroke patients and evaluated the difference between the transferred and non-transferred cohorts.
  
  
  METHODS
  We collected data on telestroke consultation, between January 2012 and June 2013, regarding patient's age, gender, diagnosis, NIHSS, onset-to-spoke time (OTS), tPA administration and transfer status. Further data was obtained on transferred patients regarding discharge and endovascular interventions.
  
  
  RESULTS
  The means of age, NIHSS and OTS time were the following: 67.59 years, 7.65 and 11.28h respectively. The proportion of transferred patients was 12.04% (280/2324); lower than what was previously reported. The overall rate of IV tPA administration was 11.98%. Transferred patients had a significantly higher NIHSS mean (10.93 vs. 6.73; P<0.001), and were more likely to have received IV-tPA at onset (25.57 vs. 9.67; P<0.001). The age, gender proportion, stroke mimic proportion, and the mean of OTS did not differ between the two-groups (0.49 vs. 0.31; P=0.38). A logistic regression showed that NIHSS (OR=1.06, P<0.001) and tPA administration at onset (OR=2.78, P<0.001) predict the transfer. Of the transferred patients, 4.5% received endovascular intervention. The mortality rate of transferred patients was 12.9%. Other outcomes were the following: 52% discharge to rehabilitation facilities, 29% discharge to home, and 8% discharge to long-term nursing facilities.
  
  
  CONCLUSIONS
  Telestroke network is increasing the frequency of tPA usage in acute ischemic stroke and may decrease the need for transfer. Our aim was to optimize the stroke therapy to shorten the hospital stay and to increase the discharge home. This allows a better functional outcome and an additional benefit of cost-saving for the hospitals.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Zanaty
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, USA.
authors.forename: Stavropoula I
authors.initials: SI
authors.lastname: Tjoumakaris
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, USA.
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Deprince
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, USA.
authors.forename: Saurabh J
authors.initials: SJ
authors.lastname: Singhal
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Kolb
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, USA. Electronic address: pascal.jabbour@jefferson.edu.
authors.forename: Pascal M
authors.initials: PM
authors.lastname: Jabbour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D003691:Delaware; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology*; D017216:Telemedicine; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute stroke therapy; Epidemiology; Stroke; Telemedicine; Telestroke