title: Outcomes of Spoke-Retained Telestroke Patients Versus Hub-Treated Patients After Intravenous Thrombolysis: Telestroke Patient Outcomes After Thrombolysis.
abstract: OBJECTIVE
  The outcomes of patients remaining at a community spoke hospital after tissue-type plasminogen activator treatment via telemedicine are unclear. Our aim was to compare medical outcomes between these patients and those treated at a hub stroke center.
  
  
  METHODS
  We retrospectively examined patient medical records from 2006 to 2014 of 272 consecutive patients treated with intravenous tissue-type plasminogen activator at University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital, a telestroke hub, and 134 consecutive patients treated after telemedicine consultation at 5 UPMC spoke hospitals, who then remained at these hospitals (drip-and-stay). Complications included mortality, length of stay, and common poststroke medical complications. We performed multivariate analysis to identify complications that are independently increased or decreased in the drip-and-stay population. We also performed a Cox proportional hazards regression to compare long-term survival.
  
  
  RESULTS
  The drip-and-stay patients had less severe strokes (National Institutes of Health Stroke Scale score, 9.5±5.9 versus 12.7±7.1; P<0.001) and fewer large vessel occlusions (11.9% versus 36%; P<0.001). After controlling for all variables with multivariate analysis, we found that the drip-and-stay patients had an increased risk of adjusted in-hospital mortality (adjusted odds ratio 11.046; 95% confidence interval, 2.785–43.810) and having a length of stay >6 days (adjusted odds ratio, 4.696, 95% confidence interval, 2.428–9.083) [corrected]. Furthermore, the drip-and-stay patients had significantly decreased long-term survival compared with the hub patients (P<0.001).
  
  
  CONCLUSIONS
  Despite having less severe strokes, the drip-and-stay patients had an increased adjusted risk of in-hospital mortality, longer length of stay, and lower long-term survival than hub hospital patients. Further studies are needed to confirm the findings and address differences in post-tissue-type plasminogen activator medical care.
authors.affiliation: From the School of Medicine, University of Pittsburgh, PA (D.L.H.); Department of Neurologic Surgery (P.D.T.), Department of Neurologic Surgery (Y.-F.C.), and Department of Neurology (L.W.), University of Pittsburgh Medical Center, PA; and Undergraduate College of Arts and Sciences at New York University (P.P.).
authors.forename: Danielle L
authors.initials: DL
authors.lastname: Heffner
authors.affiliation: From the School of Medicine, University of Pittsburgh, PA (D.L.H.); Department of Neurologic Surgery (P.D.T.), Department of Neurologic Surgery (Y.-F.C.), and Department of Neurology (L.W.), University of Pittsburgh Medical Center, PA; and Undergraduate College of Arts and Sciences at New York University (P.P.). thirumalapd@upmc.edu.
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
authors.affiliation: From the School of Medicine, University of Pittsburgh, PA (D.L.H.); Department of Neurologic Surgery (P.D.T.), Department of Neurologic Surgery (Y.-F.C.), and Department of Neurology (L.W.), University of Pittsburgh Medical Center, PA; and Undergraduate College of Arts and Sciences at New York University (P.P.).
authors.forename: Pooja
authors.initials: P
authors.lastname: Pokharna
authors.affiliation: From the School of Medicine, University of Pittsburgh, PA (D.L.H.); Department of Neurologic Surgery (P.D.T.), Department of Neurologic Surgery (Y.-F.C.), and Department of Neurology (L.W.), University of Pittsburgh Medical Center, PA; and Undergraduate College of Arts and Sciences at New York University (P.P.).
authors.forename: Yue-Fang
authors.initials: YF
authors.lastname: Chang
authors.affiliation: From the School of Medicine, University of Pittsburgh, PA (D.L.H.); Department of Neurologic Surgery (P.D.T.), Department of Neurologic Surgery (Y.-F.C.), and Department of Neurology (L.W.), University of Pittsburgh Medical Center, PA; and Undergraduate College of Arts and Sciences at New York University (P.P.).
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wechsler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006785:Hospitals, University / Q000639:trends; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D017216:Telemedicine / Q000639:trends; D015912:Thrombolytic Therapy / Q000401:mortality* / Q000639:trends; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: length of stay; stroke; telemedicine; thrombolytic therapy; tissue-type plasminogen activator