Abstract TP46: Rates Of Symptomatic Intracerebral Hemorrhage After Tpa At Rural Telemedicine Spoke And Hub Sites

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Introduction: Symptomatic intracerebral hemorrhage (sICH) is the primary bad outcome monitored post-alteplase (tPA) administration for treatment of acute ischemic stroke (AIS). Risk of sICH ranges from 2-7% based on patient population. However, little is reported on sICH with the use of telestroke, particularly in the rural setting. We evaluated rates of sICH after tPA administration for our telestroke process in a rural Texas spoke-hub system. Methods: Patient data was prospectively collected from 6/2018 (start of telestroke system) to 5/2021, including age, sex, race/ethnicity, tPA administration, door-to-needle times and sICH. Patients were included if >18 years old and underwent tPA administration at the hub or telemedicine spoke site in a rural Texas healthcare system. Six spokes and one hub were included in this study. Documented sICH was retrospectively abstracted from the database with the primary outcome comparing sICH rate between the hub and spokes. Statistical analysis was conducted by chi-square analysis. Results: A total of 160 patients received tPA at the hub and 239 at the spokes. Four patients suffered sICH at the hub and five at spokes (2.5% v 2.1%, p=0.793). Rates of tPA administration were not significantly different. Demographic comparison between spoke and hub were significantly different. Notably, there was a higher proportion of male and non-white patients at the hub compared to spoke sites, adding to the variation in populations. Patients were older at spoke sites. Conclusion: There was no difference in rates of tPA administration and rate of sICH between hub and spokes in a rural Texas telemedicine program. Rate of sICH in this setting was similar to rate reported in the literature. Furthermore, though there was a statistically significant difference between the populations studied, the likelihood of sICH remained similar. These findings further support the safety of telemedicine use for acute stroke care and tPA administration.

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