Objectives

Most data on telestroke utilization come from single academic hub-and-spoke telestroke networks. Our objective was to describe characteristics of telestroke consultations among a national sample of telestroke sites on one of the most commonly used common vendor platforms, prior to the COVID-19 public health emergency.

Materials and methods

A commercial telestroke vendor provided data on all telestroke consultations by two specialist provider groups from 2013-2019. Kendall's τ β nonparametric test was utilized to assess time trends. Generalized linear models were used to assess the association between hospital consult utilization and alteplase use adjusting for hospital characteristics.

Results

Among 67,736 telestroke consultations to 132 spoke sites over the study period, most occurred in the emergency department (90%) and for stroke indications (final clinical diagnoses: TIA 13%, ischemic stroke 39%, hemorrhagic stroke 2%, stroke mimics 46%). Stroke severity was low (median NIHSS 2, IQR 0–6). Alteplase was recommended for 23% of ischemic stroke patients. From 2013 to 2019, times from ED arrival to NIHSS, CT scan, imaging review, consult, and alteplase administration all decreased (p<0.05 for all), while times from consult start to alteplase recommendation and bolus increased (p<0.01 for both). Transfer was recommended for 8% of ischemic stroke patients. Number of patients treated with alteplase per hospital increased with increasing number of consults and hospital size and was also associated with US region in unadjusted and adjusted analyses. Longer duration of hospital participation in the network was associated with shorter hospital median door-to-needle time for alteplase delivery (39 min shorter per year, p=0.04).

Conclusions

Among spoke sites using a commercial telestroke platform over a seven-year time horizon, times to consult start and alteplase bolus decreased over time. Similar to academic networks, duration of telestroke participation in this commercial network was associated with faster alteplase delivery, suggesting practice improves performance.

中文翻译：

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在 COVID-19 大流行之前，美国商业平台中 Telestroke 使用的全国趋势

目标

大多数关于电击利用的数据来自单一的学术中心辐射电击网络。我们的目标是描述在 COVID-19 公共卫生紧急情况之前，在最常用的常见供应商平台之一上的全国电话咨询站点样本中电话咨询的特征。

材料和方法

一家商业电话供应商提供了 2013 年至 2019 年两个专业供应商团体的所有电话咨询数据。Kendall 的 τ β 非参数检验用于评估时间趋势。广义线性模型用于评估医院咨询使用和阿替普酶使用之间的关联，并根据医院特征进行调整。

结果

在研究期间对 132 个分支站点的 67,736 次电话咨询中，大多数发生在急诊科 (90%) 和中风适应症（最终临床诊断：TIA 13%，缺血性中风 39%，出血性中风 2%，中风模拟 46% ）。中风严重程度较低（中位 NIHSS 2，IQR 0-6）。阿替普酶被推荐用于 23% 的缺血性卒中患者。从 2013 年到 2019 年，从 ED 到达到 NIHSS、CT 扫描、影像检查、会诊和阿替普酶给药的次数均减少（p<0.05），而从开始就诊到阿替普酶推荐和推注的次数增加（p< 0.01 两者）。8% 的缺血性卒中患者推荐转院。每家医院接受阿替普酶治疗的患者数量随着咨询次数和医院规模的增加而增加，并且在未调整和调整的分析中也与美国地区相关。医院参与网络的持续时间越长，阿替普酶分娩的住院时间中位数越短（每年缩短 39 分钟，p = 0.04）。

结论

在七年时间范围内使用商业电击平台的辐条站点中，咨询开始和阿替普酶推注的时间随着时间的推移而减少。与学术网络类似，参与这个商业网络的电击持续时间与更快的阿替普酶递送有关，这表明练习可以提高表现。