Telestroke and Timely Treatment and Outcomes in Patients With Acute Ischemic Stroke

 So, complete fucking failure at business101; not even measuring 100% recovery! Does anyone in stroke KNOW HOW TO THINK?

But you don't tell us 100% recovery results; the only goal in stroke! Why, because you're not measuring it or because they are still so fucking awful?

Here is your business101 requirements.

“What's measured, improves.” So said management legend and author Peter F. Drucker  

The latest crapola here:

Telestroke and Timely Treatment and Outcomes in Patients With Acute Ischemic Stroke

1. Brian Stamm, MD, MSc^1,2,3,4; Rachael T. Whitney, PhD⁵; Regina Royan, MD, MPH^1,2,6,7
2. et al

Key Points

Question  How do treatment times and stroke outcomes in patients with acute ischemic stroke evaluated by telestroke compare with those not evaluated by telestroke?

Findings  In this cohort study of 3036 patients with acute ischemic stroke potentially eligible for thrombolysis, telestroke was associated with a higher odds of receiving thrombolysis, but significantly prolonged door-to-needle and door-in-door-out times and a lower odds of meeting guideline-concordant door-to-needle times within 60 minutes, compared with nontelestroke.

Meaning  These findings suggest that there is room to improve timely stroke treatment for patients evaluated by telestroke to ensure that all patients with ischemic stroke receive guideline-concordant, time-sensitive care(NOT RECOVERY!).

(Guidelines don't guarantee recovery; protocols do!)

Abstract

Importance  Telestroke has the potential to revolutionize acute stroke treatment by improving access to optimal stroke care, including time-sensitive care such as thrombolysis. However, it is unclear how treatment times and stroke outcomes compare between patients evaluated and not evaluated by telestroke.

Objective  To evaluate the association between telestroke use and acute stroke treatment times and outcomes.

Design, Setting, and Participants  This retrospective cohort study included patients with acute ischemic stroke aged 18 years or older presenting to 42 Paul Coverdell Michigan Stroke Registry hospitals from January 1, 2022, to December 31, 2023. All patients were potentially eligible for thrombolysis (ie, presented ≤4 hours of last known well, no contraindications to thrombolysis documented).

Exposure  Telestroke (vs nontelestroke) encounter.

Main Outcomes and Measures  The primary outcomes were receipt of thrombolysis and door-to-needle (DTN) time as a continuous variable and a categorical variable (≤60 vs >60 minutes).

(TOTALLY WRONG OUTCOMES TO MEASURE! Survivors want recovery you blithering idiots, measure that!) Secondary outcomes included discharge ambulatory status, discharge destination, and door-in-door-out (DIDO) time in transferred patients. Multivariable hierarchical models evaluated associations between telestroke (vs nontelestroke) activation and outcomes, sequentially adjusting for demographics, medical history, presentation or arrival, and hospital characteristics.

Results  Among the 3036 patients with acute ischemic stroke potentially eligible for thrombolysis (mean [SD] age, 69.7 [14.5] years; 1563 male [51.5%]), 785 (25.9%) were evaluated using telestroke and 2251 (74.1%) without telestroke. A total of 1673 patients (55.1%) were treated with thrombolysis. In the fully adjusted models, patients evaluated by telestroke had a significantly higher odds of receiving thrombolysis (adjusted odds ratio, 1.61; 95% CI, 1.17-2.23) but longer DTN times (6.55 minutes longer; 95% CI, 2.12-10.97 minutes longer) and lower odds of meeting a guideline-concordant DTN time within 60 minutes (adjusted odds ratio, 0.56; 95% CI, 0.39-0.81) compared with those not evaluated by telestroke. Among 255 patients who underwent interhospital transfer, 207 (81.2%) received thrombolysis, and patients with telestroke had significantly longer DIDO times (46.90 minutes longer, 95% CI, 1.08-92.72 minutes longer).

Conclusions and Relevance  In this cohort study of patients with acute ischemic stroke potentially eligible for thrombolysis, those evaluated by telestroke had a 61% higher odds of receiving thrombolysis but a 44% lower odds of meeting guideline-concordant DTN times within 60 minutes and prolonged DIDO times compared with those not evaluated by telestroke. Future research should investigate modifiable factors that contribute to treatment delays in patients with ischemic stroke evaluated via telestroke.

Introduction

Acute ischemic stroke (AIS) treatment is not only highly efficacious but also highly time-sensitive.^1,2 Faster time to treatment with intravenous thrombolysis (door to needle [DTN]) is associated with improved outcomes in AIS.¹ For patients with a large vessel occlusion, approximately 1.9 million neurons die during each minute without treatment.³ Target: Stroke is a national quality improvement campaign by the American Heart Association (AHA) that achieved significant overall reductions in DTN times.^4-6 Since its inception in 2010, Target: Stroke has set increasingly bold benchmarks for DTN times, with the most recent goal of achieving a DTN within 60 minutes in 85% of patients treated with intravenous thrombolysis.⁷

While thrombolysis is highly efficacious for acute stroke, not all hospitals have stroke specialists. Telestroke has revolutionized the treatment of acute stroke by improving access to expert stroke care.⁸ Telestroke connects stroke specialists (typically from a comprehensive stroke center or hub site) to spoke sites (typically primary stroke centers) to aid in acute stroke decision-making and treatment.⁹ Telestroke has led to an increased uptake of acute stroke therapies, including thrombolysis,⁸ and has grown across the nation, becoming a vital component of stroke systems of care.^8,10 However, several studies from single systems found that telestroke treatment times at spoke hospitals, including DTN times, were significantly prolonged,^11-15 with worse inpatient and discharge stroke outcomes¹² compared with standard, in-person stroke care.

A larger-scale comparison of telestroke vs standard stroke care has been difficult to perform given challenges with identifying patient-level telestroke encounters in standard administrative data. The Paul Coverdell Michigan Stroke Registry started routinely tracking telestroke encounters in 2022. This study used this state-level stroke registry to compare thrombolysis treatment rates, DTN times, and other evidence-based stroke hospitalization and discharge outcomes in patients evaluated via telestroke vs not.