Long-Term Functional Outcome of Telestroke Patients Treated Under Drip-and-Stay Paradigm Compared with Patients Treated in a Comprehensive Stroke Center: A Single Center Experience

Abstract

Objective: The purpose of this study is to compare long-term functional outcome for patients who receive intravenous alteplase (tPA) at a primary stroke center (spoke) through telestroke consultations and remain at the spoke (drip-and-stay) with that for patients who receive tPA at the comprehensive stroke center (hub). Methods: Data on baseline characteristics, stroke severity on presentation, door to needle (DTN) time, the rate of symptomatic intracerebral hemorrhage (sICH) and long-term outcomes for all patients evaluated at the Medical University of South Carolina (MUSC) hub and MUSC telestroke network spoke sites between January 2016 and March 2017 were collected. Eligible patients received tPA at either the spoke or hub location during the study period. Patients who received mechanical thrombectomy were excluded from the study. Functional outcome was assessed with 90-day modified Rankin Scale (mRS). Descriptive statistics were used to compare patient demographics and clinical outcomes across the two groups. Results: Total of 426 were identified (60 hub patients and 366 drip-and-stay patients). There were no significant differences in patient age, sex, admission National Institute of Health Stroke Scale (NIHSS), sICH, or DTN times between the two groups. mRS of 0–2 at 90 days was achieved in 37 (61.7%) of the hub and in 255 (69.7%) in the drip-and-stay patients ( p = 0.216). On regression analysis, there was no difference in the adjusted relative risk of having a lower mRS between drip-and-stay and hub patients (incidence rate ratio 1.14, p = 0.278, 95% confidence interval [0.9–1.43]). Conclusion: Our study shows no difference in the long-term functional outcome for patients who received tPA through telestroke consultation and remained at spoke hospitals (drip-and-stay) compared with patients who received tPA at the hub.