Abstract Details

Title Improved Adherence to AHA Acute Stroke Treatment Guidelines Through Telestroke (TELECAST Trial)

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-010

Objective The TELECAST trial (NCT03672890) prospectively examined the impact of a 24-7 telestroke specialist service dedicated to inpatient acute stroke care spanning admission to discharge.

Background Limited access to stroke specialist expertise produces disparities in stroke treatment. The impact of telestroke on the remote delivery of guideline-based inpatient stroke care is yet to be comprehensively studied. The TELECAST trial studied acute inpatient stroke care following the implementation of a 24-7 inpatient telestroke service at a spoke hospital that did not previously have access to stroke specialists.

Design/Methods AHA stroke guidelines were used to derive outcome metrics in the following acute stroke inpatient care categories: diagnostic stroke evaluation (DSE), secondary stroke prevention (SSP), health screening and evaluation (HSE), and stroke education (SE). Adherence to AHA guidelines for stroke inpatients pre-telestroke (July 1, 2016-June 30, 2018) and post-telestroke intervention (July 1, 2018-June 30, 2019) were studied. The primary outcome was a composite score of all guideline-based stroke care. Secondary outcomes consisted of subcategory composite scores in DSE, SSP, HSE, and SE. Chi-squared tests were utilized to assess primary and secondary outcomes. Statistical analysis was performed using STATA 15.0.

Results 267 patients were included in the pre-telestroke intervention cohort and 284 in the post-telestroke intervention cohort. Following institution of a comprehensive inpatient telestroke service, overall adherence to AHA guideline-based metrics improved significantly (composite score: 84.0% vs 93.1%, p<0.01). In subgroup analysis, improvement in DSE (87.6% vs 96.4%, p<0.01), SSP (95.6% vs 98.0%, p=0.02), and SE (63.4% vs. 80%, p<0.01) was observed. The HSE adherence rates (77.1% vs. 76.3%, p=0.81) were not significantly different.

Conclusions The implementation of a 24-7 inpatient telestroke service improved adherence to AHA guidelines for inpatient acute stroke care. Dedicated inpatient telestroke specialist coverage may improve inpatient stroke care and reduce stroke recurrence in hospitals without access to stroke specialists.

Authors/Disclosures
Matthew K. Ronck, MD (SSM Health) PRESENTER	No disclosure on file
Apameh Salari, MD	Dr. Salari has nothing to disclose.
Eric Jaton, MD	No disclosure on file
	No disclosure on file
Monica Ngo, MD (University of Minnesota Medical School - Twin Cities)	Dr. Ngo has nothing to disclose.
Kathryn Bard, PA	Ms. Bard has nothing to disclose.
Amelia Solei, NP	Mrs. Solei has nothing to disclose.
Sarah A. Engkjer, RN (Minnesota Epilepsy Group)	No disclosure on file
Andrew J. Zhang, MD (Cleveland Clinic)	Dr. Zhang has nothing to disclose.
Jae H. Kim, MD (University of Minnesota)	No disclosure on file
Christine E. Yeager, MD (Rush University Medical Center)	Dr. Yeager has nothing to disclose.
Oladi S. Bentho, MD (University of Minnesota)	Dr. Bentho has nothing to disclose.
Benjamin R. Miller, MD (University of Minnesota)	The institution of Dr. Miller has received research support from StrokeNET.
Christopher Streib, MD (Department of Neurology)	Dr. Streib has nothing to disclose.

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Abstract Details