Original Article
Impact of Telemedicine Implementation in Thrombolytic Use for Acute Ischemic Stroke: The University of Pittsburgh Medical Center Telestroke Network Experience

The preliminary results of this project were presented at the 64th annual meeting of the American Academy of Neurology, New Orleans, Louisiana, April 21-28, 2012.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.02.004Get rights and content

Background

Intravenous thrombolysis is the only therapy for acute ischemic stroke that is approved by the US Food and Drug Association. The use of telemedicine in stroke makes it possible to bring the expertise of academic stroke centers to underserved areas, potentially increasing the quality of stroke care.

Methods

All consecutive admissions for stroke were reviewed for 1 year before telemedicine implementation and for variable periods thereafter. A retrospective review identified 2588 admissions for acute stroke between March 2005 and December 2008 at 12 hospitals participating in a telestroke network, including 919 patients before telemedicine was available and 1669 patients after telemedicine was available. The primary outcome measure was the rate of intravenous tissue plasminogen activator (IV tPA) use before and after telemedicine implementation.

Results

One hundred thirty-nine patients received IV tPA in both study phases, with 26 (2.8%) patients treated before starting telemedicine and 113 (6.8%) after starting telemedicine (P < .001). Incorrect treatment decisions occurred 7 times (0.39%), with 2 (0.2%) pretelemedicine and 5 (0.3%) posttelemedicine (P = .70). Arrivals within 3 hours from symptom onset were more frequent in the posttelemedicine compared to the pretelemedicine phases (55 [6%] vs 159 [9.5%]; P = .002). Among the patients treated with IV tPA, symptomatic intracranial hemorrhage occurred in 2 patients (1 [10.7%] pretelemedicine vs 1 [1.8%] posttelemedicine; P = .34).

Conclusions

Telestroke implementation was associated with an increased rate of thrombolytic use in remote hospitals within the telemedicine network.

Section snippets

Methods

This retrospective study reviewed all consecutive admissions of patients with a primary diagnosis of AIS between March 2005 and December 2008 in the 12 community hospitals that are part of the University of Pittsburgh Medical Center (UPMC) telestroke network. This study was approved by the Central Ethics Committee of UPMC, and informed consent was not required. The medical records review was based on International Classification of Diseases coding, and all admissions coded as occlusion and

Results

A total of 3409 admissions were identified, and 2588 fulfilled the criteria for possible acute stroke. Elective carotid endarterectomy was the most frequent reason for exclusion from final analysis 805 patients. Six patients diagnosed with AIS were excluded from the final analysis because of a lack of data for review.

A total of 139 patients (5.4%) received thrombolytic treatment during the study period. Among the 2588 patients, 919 (35.5%) were admitted during the pretelemedicine phase and 1669

Discussion

This study assessed the impact on frequency of IV tPA use in a community hospital network before and after telestroke support implementation. The rate of IV thrombolytic use increased after telemedicine became available in these hospitals, a finding consistent with previous reports that showed higher rates of IV tPA use in facilities that have accessibility to remote support from vascular neurologists.8, 9, 10, 11, 12 Protocol violations were unfrequent both before and after telemedicine

Acknowledgments

We thank Dr. Cindy Huynh for her assistance with manuscript review.

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Supported in part by CLIQS0000235. Dr. Jovin is a consultant for Concentric Medical, Inc., Covidien, eV3, NIT, and Stryker. Dr. Wechsler is a member of the Dias 3/4 Data and Safety Monitoring Board.

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