Introduction: Telestroke medicine (TM) involves clinical stroke care by digitally connecting patients and their providers to neurovascular specialists to decrease the time to thrombolytic reperfusion during an acute ischemic stroke (AIS). Rapid administration of intravenous tissue plasminogen activator (iv-tPA) improves AIS outcomes yet no large scale research has evaluated the effectiveness of TM. This study proposes that TM utilization across the Jefferson University Hospital network will increase thrombolytic reperfusion rates and improve overall stroke outcomes.
Methods: A retrospective cohort study design with data from a Jefferson Telestroke database contained information for 9,702 patients across 36 hospital affiliates. These patients were evaluated for an AIS through Telestroke from 2014-2019. The rate of iv-tPA administration and NIHSS stroke severity scores were collected. This data was then compared to previous studies that represent the current standard of care without Telestroke through utilization of T-test and ANOVA analysis.
Results: An analysis is currently in progress. Preliminary analysis demonstrated that 807 out of 9,702 patients (8.3%) evaluated for AIS received iv-tPA when compared to a national average of 3.4%-5.2%. Additionally, a statistically significant improvement in NIHSS score from baseline to after administration of iv-tPA (p<0.0001; 95% confidence interval [CI] = 4.27, 7.80) was found in this cohort.
Discussion: The results of this study support the hypothesis that TM increases the rate of administration of iv-tPA when compared to the national average and improves AIS outcomes. The study describes the effectiveness of TM and demonstrates a need for implementation of Telestroke nationally to improve stroke care.
Joffe, Daniel; Sweid, Ahmad; Moylan, Daniel; Morse, Charles; Knapp, Michael; and Jabbour, Pascal, "Evaluating the Efficacy of Telestroke Intervention on Stroke Care in a Large Hospital Network" (2021). Phase 1. Paper 81.