Accuracy of Stroke Diagnosis in Telestroke-Guided Tissue Plasminogen Activator Patients.
OBJECTIVE
The objective of the study is to assess the accuracy of final diagnosis in telestroke-guided tissue plasminogen activator (rt-PA) patients compared with bedside evaluation using computed tomography (CT) or magnetic resonance imaging (MRI) as a surrogate for final stroke diagnosis. The overall goal was to determine if telestroke had similar diagnostic accuracy as bedside evaluations in diagnosing rt-PA-treated patients.


METHODS
We analyzed all acute stroke code calls who received intravenous rt-PA at our center from October 2013 to June 2015. Calls were grouped into patients who were initially evaluated by telestroke at a spoke partner site (spoke) and patients evaluated in person at the hub. Patients receiving additional neurointervention were excluded to avoid confounding. Relevant variables included severity of stroke (National Institutes of Health Stroke Scale [NIHSS]), rt-PA times, presence of intracranial hemorrhage (ICH), and primary outcome of CT or MRI evidence of stroke after rt-PA administration. Post-rt-PA imaging used included CT or MRI within 72 hours after treatment.


RESULTS
Overall, 80 patients received intravenous rt-PA (spoke [n = 23] and hub [n = 57]). There was no difference in mean NIHSS score prior to treatment (10.3 ± 9.2 and 9.8 ± 8.4; P = .936), "onset-to-treatment" time (143.6 ± 53.5 minutes and 141.0 ± 54.1 minutes; P = .915), and ICH rate (13% and 8.8%; adjusted P = .898). The presence of radiographic evidence of stroke at spoke versus hub was not different (78.3% and 66.7%; adjusted P = .338). The most commonly used radiographic modality was MRI (MRI: 80%, CT: 20%).


CONCLUSIONS
Using imaging as a surrogate for final diagnosis resulted in no difference in final stroke diagnosis rate between the groups, reinforcing that telestroke evaluations are as accurate as bedside evaluations in diagnosing acute stroke.
University of California, San Diego, California. Electronic address: agrkun@gmail.com.
Kunal
K
Agrawal
University of Southern California, Los Angeles, California.
Rema
R
Raman
University of Southern California, Los Angeles, California.
Karin
K
Ernstrom
University of California, San Diego, California.
Robert Joseph
RJ
Claycomb
University of California, San Diego, California.
Dawn Matherne
DM
Meyer
University of California, San Diego, California.
Thomas Martin
TM
Hemmen
University of California, San Diego, California.
Royya Fatima
RF
Modir
Temecula Valley Hospital, Temecula, California.
Pranav
P
Kachhi
University of California, San Diego, California.
Brett Cowan
BC
Meyer
D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002533:Cerebral Angiography / Q000379:methods*; D000072226:Computed Tomography Angiography; D004185:Disability Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D019114:Remote Consultation / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
Acute stroke; computed tomography; diagnostic accuracy; emergency medicine; magnetic resonance imaging; neuroimaging; telestroke; tissue plasminogen activator