We hypothesized that ischemic stroke (IS) patients evaluated in spoke Emergency Departments (EDs) via telestroke, then managed with telestroke follow-up (TSF), have similar outcomes to those seen by in-person neurology follow-up (IPF) after admission.

Community EDs often transfer IS patients for lack of neurology coverage, burdening patients and accepting facilities. Telestroke improves access to acute stroke care, but data lack on inpatient telestroke care.

We identified 3702 IS patients seen via telestroke at spoke EDs in our network (9/2015–12/2018). We excluded patients who were transferred by the ED after initial evaluation. Of 1906 total telestroke patients admitted and seen by either TSF or IPF, we compared baseline demographic and clinical characteristics, and patient- and hospital-level outcomes.

There were 447 (23%) patients who underwent TSF and 1459 (77%) seen by IPF. Both groups presented with similar stroke severity. In the multivariate analysis, there were no significant differences in discharge disposition, stroke readmission rates, and 90-day mRS, although TSF length-of-stay was shorter (p=0.01). There was a higher proportion of Non-Hispanic Black patients (p<0.0001) and a lower proportion of Hispanic patients (p<0.0001) in the TSF group, possibly reflecting spoke location demographics. Only 3% of the telestroke patients were transferred after admission; none seen by IPF were transferred. Minimal tPA complications occurred in both groups. TNF patients were less likely to have received tPA or endovascular therapy than IPF (p<0.0001). Accounting for only tPA recipients, and also when removing CSCs from the IPF group, revealed no difference in outcomes.

IS patients receiving TSF have comparable outcomes when compared to those that are seen by IPF, with few subsequent transfers after admission. Telestroke may decrease length of stay compared to IPF. For select IS patients, TSF provides an alternative to transfer for hospitals lacking resources for IPF coverage.