Effect of telestroke practices on short-term mortality in ischemic stroke patients

Abstract

Objective This study aimed to evaluate the effect of telestroke practices on patient prognosis and mortality by comparing the data of patients that presented before and during a period when tele-stroke application was in use. Method Stroke patients presenting from October, 2018 to October, 2019 for whom WhatsApp was used for telestroke purposes, were evaluated as the telestroke group. The previous year it was a pre-telestroke group. The two groups were compared in terms of factors affecting prognosis and mortality. All statistical analyses were performed using SPSS version 16.0 for Windows. Results A total of 727 patients clinically and radiologically confirmed to have ischemic stroke were included in the study. There were 252(34.6%) patients in the pre-telestroke group and 475(65,4%) patients in the telestroke group. Both rtPA and thrombectomy treatment were significantly higher in the telestroke group(p<0.001). In the first 24-hour evaluation, the rate of discharge increased and hospital admission and mortality decreased in the telestroke group(p<0.001). There was no statistically significant difference between the groups in terms of poor prognosis and 30-day mortality(p=0.470 and p=0.625, respectively). Conclusion Telestroke practices not only provide access to the relevant clinical branch for early consultation but also facilitate timely treatment thus leading to improvement in prognosis.

Keywords

• telestroke,
• ischemic stroke,
• r-tPA
• thrombectomy,
• WhatsApp application

References

1. 1. Szelenberger R, Kostka J, Saluk-Bijak J, Miller E. Pharmacological Interventions and Rehabilitation Approach for Enhancing Brain Self-repair and Stroke Recovery, Home/Current. Neuropharmacology 2020(18);1:51-64. Doi:10.2174/1570159X17666190726104139.
2. 2. Fonarow GC, XinZhao MS, Smith EE et al. Door-toneedle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA 2014;311:1632-40. Doi:10.1001/jama.2014.3203.
3. 3. Powers WJ, Rabinstein AA, Ackerson T et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke 2018;49(3):e46–e99. Doi:10.1161/STR.0000000000000158.
4. 4. Schimpf B, Deanda K, Severenuk DA et al. Integration of Real-Time Electronic Health Records and Wireless Technology in a Mobile Stroke Unit. J Stroke Cerebrovasc Dis 2019(28);9:2530-6. Doi:10.1016/j.jstrokecerebrovasdis.2019.06.008.
5. 5. Maingard J, Phan K, Lamanna A et al. Rescue intracranial stenting following failed mechanical thrombectomy for acute ischaemic stroke: a systematic review and meta-analysis. World Neurosurgery 2019;132:e235-e245. Doi:10.1016/j.wneu.2019.08.192.
6. 6. Saadi A, Mateen FJ. International issues: teleneurology in humanitarian crises. Neurology 2017;89(3):16-9. Doi:10.1212/wnl.0000000000004114.
7. 7. Sarfo FS, Adamu S, Awuah D, Ovbiagele B. Tele-neurology in sub-Saharan Africa: a systematic review of the literature. J NeurolSci 2017;380:196-9. Doi:10.1016/j.jns.2017.07.037.
8. 8. Inan I, Algin A, Sirik M. WhatsApp as an Emergency Teleradiology Application for Cranial CT Assessment in Emergency Services. J Coll Physicians Surg Pak 2020;30(7):730-4. Doi:10.29271/jcpsp.2020.07.730.

9. 9. Patel UK, Malik P, DeMasi M, Lunagariya A, Jani VB. Multidisciplinary Approach and Outcomes of Tele-neurology: A Review. Cureus 2019;11(4):4410. Doi:10.7759/cureus.4410.
10. 10. Calleja-Castillo JM, Gonzalez-Calderon G. Whatsapp in stroke systems: current use and regulatory concerns. Front Neurol 2018;9:388. Doi:10.3389/fneur.2018.00388.
11. 11. Ford S, Ajani Z, Chen Q et al. Comparison of Standard Emergency Room Care with Tele-Stroke Evaluation in Acute Intracerebral Hemorrhage Management. Stroke 2016;47(1):AWP367.
12. 12. Baratloo A, Rahimpour L, Abushouk AI, Safari S, Lee CW, Abdalvand A. Effects of Telestroke on Thrombolysis Times and Outcomes: A Meta-analysis. Prehospital Emergency Care 2018;22(4):472-84. Doi: 10.1080/10903127.2017.1408728.
13. 13. Barna PM, Hubert GJ, Boy S et al. TeleStroke Units Serving as a Model of Care in Rural Areas 10-Year Experience of the Tele Medical Project for Integrative Stroke Care. Stroke 2014;45(9):2739-44. Doi:10.1161/STROKEAHA.114.006141.
14. 14. Mazighi M, Meseguer E, Labreuche J et al. TRUST-Tpa trial: Telemedicine for remote collaboration with urgentists for stroke-tPA treatment. Journal of Telemedicine and Telecare 2016;23(1):174-80. Doi:10.1177/1357633X15615762.
15. 15. Lee VH, Cutting S, Song SY et al. Participation in a TeleStroke Program Improves Timeliness of Intravenous Thrombolysis Delivery. Telemedicine and e-Health 2017;23(1):60-2. Doi:10.1089/tmj.2016.0014.
16. 16. Gutowitz S, Legget J, Hart L, Leaman SM, James H, Stillinger T. The impact of teleneurologists on acute stroke care at an advanced primary stroke centre. J TelemedTelecare 2020. Doi: 10.1177/1357633X20921039.
17. 17. Bergrath S, Reich A, Rossaint R et al. Feasibility of Prehospital Teleconsultation in Acute Stroke – A Pilot Study in Clinical Routine. PLoSONE. 2012;7(5):36796. Doi:10.1371/journal.pone.0036796.g004.A.
18. 18. Sanchez S, Campos Y, Cadena A et al. Intravenous thrombolysis in the elderly is facilitated by a tele-stroke network: A cross-sectional study. Clinical Neurology and Nourosurgery 2020:197:106177. Doi: 10.1016/j.clineuro.2020.106177.