Abstract P178: Rapid Improvement in Timely tPA Administration With Initiation of Telestroke in a Predominantly Rural Catchment Area

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Introduction: In acute ischemic stroke (AIS) treatment, reduction in tPA Door-To-Needle time (DTN) by 15 minutes improves functional outcomes. Telestroke has demonstrated timely tPA administration over several years of implementation. However, telestroke care in the rural setting is less well characterized, and many telestroke studies have only shown improvement in DTN over longer periods. We evaluated reduction in DTN over a 6 month period after implementing an internal telestroke process in a rural spoke-hub model in central Texas. Methods: Data was abstracted from local databases from 6 months before and 6 months after initiation of telestroke at each center over years 2017-2019. Patients who presented to the emergency room at 1 of 5 spokes in central Texas with AIS symptoms were included, 393 pre-telestroke and 362 post. Patients who did not receive tPA were excluded. Patients with documented delay such as initial tPA refusal, further imaging or management of acute comorbidities were also excluded, leaving 80 cases, 33 pre-telestroke and 47 post. Chi-square analyses for changes in DTN were used. T-test analysis was used for continuous variables. Primary outcome assessed reduction in DTN with secondary outcome of number of tPA administrations. Results: Total stroke volume did not increase over the study period [average per site pre-telestroke 78.6 (SD 58.1) and post-telestroke 72.4 (SD 45.7)] ( t (4)=0.91, p =0.42). Attainment of <45 minute DTN improved from 18.2% pre- to 48.9% post-telestroke ( p = 0.01), and <60 minute DTN improved from 36.3% to 80.1% ( p <0.0001). Total tPA volume at each site increased over the period, with a moderate effect size though not statistically significant (average per site of 6.6 administrations pre-telestroke to 9.4 post-telestroke, t (4)=-1.72, p =0.16, d=-0 .77) Conclusions: Telestroke within a rural catchment area in central Texas resulted in significant reduction in DTN within 6 months of implementation. This study showed that successful telestroke processes can be implemented in a relatively short time period even in the rural setting. Further investigation of telestroke at rural stroke centers is needed to improve access and quality of care.

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