We aimed to examine differences in telestroke utilization and practice before and after extending our call window to 24 hours based on 2018 acute ischemic stroke guidelines.

We examined prospectively collected data as part of our telestroke quality program and analyzed the data retrospectively. We compared patients evaluated by telestroke in the year preceding and following extension of our call window to 24 hours.  We compared number of consults using a t test.  Additionally, we utilized a stepwise logistic regression model to evaluate differences in covariates (age, sex, NIHSS, telephone/video consult, IV alteplase administration and stroke thrombectomy administration) before and after extending the telestroke call window in our network. The number of telestroke sites in our network did not change during this study. 

Significantly more telestroke consults were requested in the year following extension of the call window to 24 hours (1286) compared to before (986), p<0.0001, d=0.48. A logistic regression suggested that after the extension of the call window, fewer telestroke consults went to video p < 0.0001, OR=0.54 (95%CI 0.45-0.66), but more patients were identified and underwent stroke thrombectomies compared to before p=0.008, OR=1.77 (95%CI 1.16-2.71).  There were no differences in age (p=0.47), sex (p=0.30), NIHSS (p=0.44) or proportion of telestroke patients receiving IV alteplase (p=0.12) when comparing before and after extending the telestroke window.