Telemedicine Use in Stroke Linked to Delayed Treatment

 This should make no difference whatsoever! COMPETENT? HOSPITALS WILL HAVE 100% RECOVERY PROTOCOLS REGARDLESS OF TIME PRESENTED!

So, your hospital is completely fucking incompetent then?

Telemedicine Use in Stroke Linked to Delayed Treatment

TOPLINE:

Evaluation via telemedicine in stroke care, or “telestroke,” enhances access to thrombolysis for acute ischemic stroke but leads to significant treatment delays, with patients 44% less likely to receive guideline-concordant door-to-needle (DTN) times within 60 minutes, a multicenter registry study showed. While improving treatment accessibility, telestroke evaluation was associated with 6.55 minutes longer DTN times and 47 minutes longer door-in-door-out (DIDO) transfer times than standard care.

METHODOLOGY:

• Researchers analyzed 3036 patients with acute ischemic stroke (mean age, 70 years; 51.5% men; 77.5% White individuals) in 42 hospitals from the Paul Coverdell Michigan Stroke Registry between 2022 and 2023.
• Participants potentially eligible for thrombolysis were evaluated either using telestroke (26%) or without it (74%).
• Primary outcomes were administration of thrombolysis and DTN treatment time as both continuous and categorical variables (≤ 60 vs > 60 minutes).
• Secondary outcomes included the occurrence of postthrombolytic symptomatic intracerebral hemorrhage (ICH), in-hospital mortality, discharge modified Rankin Scale (mRS) score, discharge ambulatory status, discharge destination, DTN treatment time, and DIDO time of transferred patients. The outcomes were adjusted for demographics, medical history, and patient and hospital characteristics.

TAKEAWAY:

• Thrombolysis was administered to 55.5% of patients evaluated via telestroke vs 55.0% evaluated without it, with evaluation via telestroke associated with higher odds of receiving thrombolysis (adjusted odds ratio [aOR], 1.61; P = .003) but lower odds of receiving it within 60 minutes (aOR, 0.56; P = .002).
• Patients evaluated by telestroke had delayed treatment with longer DTN (mean difference 6.55 minutes; P = .003) and median DTN (53 vs 46 minutes; P < .001) treatment times as well as a longer median DIDO time (166 vs 150 minutes; P < .001) than those not evaluated by telestroke.
• Fewer patients evaluated by telestroke received guideline-concordant DTN treatment within 60 minutes than those not evaluated by telestroke (60.3% vs 72.3%; P < .001).
• Outcomes including postthrombolytic symptomatic ICH, in-hospital mortality, discharge mRS score, ambulatory status, and discharge destination did not differ significantly between groups after adjustment.

IN PRACTICE:

“Telestroke care has the potential to revolutionize acute stroke treatment by improving access to lifesaving treatment, but our findings highlight clear gaps in the ability to promptly treat these patients after they are evaluated. This is a major opportunity for quality improvement to identify unique factors in telestroke systems that contribute to treatment delays,” the lead author said in a press release.

The authors of an accompanying editorial wrote, “Improvement efforts should address processes at both hub and spoke hospitals. With continued assessment of processes and outcomes across stroke systems of care, and collaboration beyond traditional health system boundaries, we can further improve outcomes for patients treated with telestroke.”

SOURCE:

The study was led by Brian Stamm, MD, clinical assistant professor of neurology at University of Michigan Medical School, Ann Arbor, Michigan. The accompanying editorial was authored by Laura K. Stein, MD, MPH, Icahn School of Medicine, Mount Sinai, New York City, and Kori S. Zachrison, MD, MSc, Mass General Brigham and Harvard Medical School, Boston. The commentary and the study were published online on September 26 in JAMA Network Open.