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Introduction: Telemedicine for acute ischemic stroke (Telestroke) allows live consultation between patients, remote stroke specialists, and providers to facilitate administration of IV tissue plasminogen activator (IV-tPA) within the 4.5 hour window. Small cohort studies have demonstrated thrombolytic therapy conveys significant benefit to stroke outcomes and yet is underutilized due to difficulties in recognition and delivery of medication. This study proposes that access to telestroke care across the Thomas Jefferson University Hospital network will result in increased thrombolytic reperfusion rates and improved patient outcomes for stroke.

Methods: A retrospective cohort study was designed to utilize a telestroke database collecting information from 9,702 patients evaluated through telestroke across the Jefferson network of 36 community hospitals from 2014-2019. The rate of tPA administration and NIHSS stroke scores were collected. These rates were compared to values in the literature that represent current standard of care without telestroke.

Results: Analysis is not complete due to difficulties with the size of the dataset. Preliminary analysis reveals that 807 of the 9,702 patients (8.3%) evaluated for stroke received tPA compared to a national rate of 3.4-5.2% in stroke patients. Furthermore, tPA administration resulted in a significant improvement in NIHSS stroke scale (p<0.0001; 95% confidence interval [CI] = 4.27, 7.80).

Discussion: The results support the hypothesis that tPA is administered effectively though a telestroke system. The greater rate of administration across a large cohort implies significantly improved outcomes for patients on a large scale. The study supports the implementation of large telestroke systems similar to Jefferson’s for improved care.