Outcomes of Spoke-Retained Telestroke Patients Versus Hub-Treated Patients After Intravenous Thrombolysis: Telestroke Patient Outcomes After Thrombolysis.

Abstract

The outcomes of patients remaining at a community spoke hospital after tissue-type plasminogen activator treatment via telemedicine are unclear. Our aim was to compare medical outcomes between these patients and those treated at a hub stroke center. We retrospectively examined patient medical records from 2006 to 2014 of 272 consecutive patients treated with intravenous tissue-type plasminogen activator at University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital, a telestroke hub, and 134 consecutive patients treated after telemedicine consultation at 5 UPMC spoke hospitals, who then remained at these hospitals (drip-and-stay). Complications included mortality, length of stay, and common poststroke medical complications. We performed multivariate analysis to identify complications that are independently increased or decreased in the drip-and-stay population. We also performed a Cox proportional hazards regression to compare long-term survival. The drip-and-stay patients had less severe strokes (National Institutes of Health Stroke Scale score, 9.5±5.9 versus 12.7±7.1; P<0.001) and fewer large vessel occlusions (11.9% versus 36%; P<0.001). After controlling for all variables with multivariate analysis, we found that the drip-and-stay patients had an increased risk of adjusted in-hospital mortality (adjusted odds ratio 11.046; 95% confidence interval, 2.785–43.810) and having a length of stay >6 days (adjusted odds ratio, 4.696, 95% confidence interval, 2.428–9.083) [corrected]. Furthermore, the drip-and-stay patients had significantly decreased long-term survival compared with the hub patients (P<0.001). Despite having less severe strokes, the drip-and-stay patients had an increased adjusted risk of in-hospital mortality, longer length of stay, and lower long-term survival than hub hospital patients. Further studies are needed to confirm the findings and address differences in post-tissue-type plasminogen activator medical care.