In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
Abstract:
Introduction: Telemedicine (TM) is increasingly utilized for tPA delivery. The destination of the patient after tPA, whether to stay at the presenting hospital or transfer to a hub stroke center, is unclear. A prior US study showed that TM tPA treated patients who stayed at their presenting hospital had longer length of stay (LOS), worse discharge dispositions (DD), and an increased in-hospital mortality (IHM). We did a similar analysis to assess reproducibility in our TM network. Objective: We hypothesized that there would be no difference in LOS, IHM, and discharge disposition (DD) between drip and stay (DST) and drip and hub transfer (DSH) in our network. Methods: We identified patients treated with tPA at of one our 19 spoke hospitals between 9/2015 and 12/2016. Demographic, clinical, and outcome data were obtained from our TM registry. We compared characteristics of DST and DSH patients using univariate analyses including student t-test, Wilcoxon sum rank, or chi square analyses where appropriate. We used negative binomial regression, logistic regression, and multinomial regression to evaluate LOS, IHM, and DD. Results: Among 430 TM patients, 232 (53.9%) were transferred to the hub following tPA treatment. The median presenting NIHSS was significantly higher for DSH (10; IQR 5,6) compared to DST (6; IQR 4-10; p 〈 0.001), but other characteristics were similar. Though median LOS was significantly higher for DSH in the univariate analysis (p 〈 0.01), there was no significant difference in the adjusted analysis. There were no significant differences in IHM or DD. Conclusion: There are no differences in LOS, IHM, or DD comparing DSH and DST patients. The DSH patients had higher NIHSS but were otherwise similar. Our findings did not corroborate a prior study and instead suggest that it is safe for TM tPA patients to remain at spoke hospitals. Further studies across multiple TM networks are needed to confirm the quality of the drip and stay model of care.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.49.suppl_1.WP270
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2018
detail.hit.zdb_id:
1467823-8
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