By Matthew E. Fink, MD
Louis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, New York Presbyterian/Weill Cornell Medical College
SOURCE: Wilcock AD, Schwamm LH, Zubizarreta JR, et al. Reperfusion treatment and stroke outcomes in hospitals with telestroke capacity. JAMA Neurol 2021;78:527-535.
Real-time video conferencing between the patient, a remotely located stroke specialist, and the bedside healthcare provider in a hospital emergency department is referred to as “telestroke.” This modality for evaluation and treatment of acute stroke patients has been in use for more than 20 years and now has been disseminated widely worldwide. However, there are little data comparing its benefit with in-person evaluation and treatment for hospitals that do not have in-hospital stroke specialists 24 hours per day, seven days per week.
The investigators reviewed data from 643 hospitals with telestroke capability and matched them with a similar number from hospitals that did not have telestroke, derived from a Medicare database. The final study sample consisted of 153,272 patients, evenly divided between telestroke hospitals and those that did not have telestroke capability. Of the patients, 57.7% were female and the mean age was 78.8 years.
The primary outcome measure was receipt of reperfusion treatment through intravenous thrombolysis or thrombectomy, mortality at 30 days from admission, cost of care in the first 90 days from admission, and functional status at 90 days as measured by the time spent living in the community after discharge.
Patients who were treated at telestroke hospitals had a higher rate of reperfusion treatment compared to those who were evaluated at the control hospitals (6.8% vs. 6.0%; P < 0.001), and a lower 30-day mortality (13.1% vs. 13.6%; P = 0.003). There were no significant differences in the time spent living in the community following discharge nor were there any significant differences in costs of care for the first 90 days. The benefits of telestroke were greatest in low-volume hospitals, in rural areas, and among patients who were 85 years of age and older. In conclusion, the availability of telestroke resulted in a higher rate of reperfusion treatment and lower 30-day mortality.