Background:
Most data on telestroke utilization come from single academic hub-and-spoke telestroke networks. Our objective was to describe trends in telestroke consultations among a national sample of telestroke sites using a common commercial vendor platform.
Methods:
A major commercial telestroke vendor (InTouch Health) provided data on all telestroke consultations by two provider service organizations from 2013-2019. Kendall’s τ β nonparametric test was utilized to assess time trends and generalized linear models assessed the link between hospital consult utilization and alteplase (tPA) performance adjusting for hospital characteristics.
Results:
Among 67,736 telestroke consultations to 132 spoke sites, most occurred in the emergency department (90%) and for stroke indications (TIA 13%, ischemic stroke (IS) 39%, hemorrhagic stroke 2%, other 46%).Median NIHSS was low (2 (IQR 0-6). tPA was recommended for 23% of IS patients. From 2013 to 2019, times from ED arrival to NIHSS, CT scan, imaging review, consult, and tPA administration all decreased (p<0.05 for all), while times from consult start to tPA recommendation and bolus increased (p<0.01 for both). Transfer was recommended for 8% of IS patients diagnosed. Number of patients treated with tPA per hospital was significantly associated with number of consults, size and US region in unadjusted and adjusted analyses (Table). After accounting for hospital characteristics, only duration of hospital participation in the network was associated with shorter hospital median door-to-needle time for tPA delivery (39 minutes shorter per year, p=0.04).
Conclusion:
In this network, times to consult start and tPA bolus decreased over time, though performance varied by telestroke consult volume and region. Duration of telestroke participation was associated with faster tPA delivery, suggesting practice improves performance. Commercial telestroke networks appear to behave similarly to academic networks.