Abstract Details

Title Inpatient Telestroke Coverage Improves Guideline-based Diagnostic Stroke Evaluation: Results from the TELECAST trial

Topic Cerebrovascular Disease and Interventional Neurology

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

Poster/Presentation
Number 4-006

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. The
primary and secondary outcomes of TELECAST are presented separately (abstract 3928).

Background Preliminary results of the TELECAST trial demonstrated improvement in guideline-based
delivery of acute stroke care following the implementation of a 24-7 inpatient telestroke service
at a spoke hospital without prior access to stroke specialists. Improvement was specifically
noted in diagnostic stroke evaluation (DSE) metrics; we present these subgroup findings in full
detail.

Design/Methods AHA stroke guidelines were used to determine DSE metrics for inpatient stroke care, including:
neurologist evaluation, brain imaging (CT or MRI), intracranial vascular imaging, carotid vascular
imaging, EKG, telemetry, outpatient cardiac monitoring, LDL, A1c, and troponin. Adherence to
these DSE criteria were studied for stroke inpatients pre-telestroke (July 1, 2016-June 30, 2018)
and post-telestroke intervention (July 1, 2018-June 30, 2019). Chi-squared tests were utilized
to assess for statistical significance (?=0.05). 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 DSE guideline-based metrics improved (87.6% vs 96.4%, p<0.01).
Individually, neurologist evaluation (93.0% vs 99.4%, p<0.01), LDL (90.1% vs 97.6%, p<0.01), A1c
(62.8% vs. 94.8%, p<0.01), troponin (78.8% vs 93.5%, p<0.01), and discharge with outpatient
cardiac monitoring for embolic stroke of undetermined source (42.6% vs. 81.0%, p<0.01) were
significantly improved.

Conclusions Access to a neurologist, completion of recommended laboratory evaluation, and use of
indicated outpatient cardiac monitoring for acute stroke patients was improved post-telestroke
intervention. Inpatient telestroke coverage facilitated improvement in guideline-based DSE for
acute stroke patients. This could result in more directed secondary stroke prevention with the
potential to decrease stroke recurrence.

Authors/Disclosures
Monica Ngo, MD (University of Minnesota Medical School - Twin Cities) PRESENTER	Dr. Ngo has nothing to disclose.
Matthew K. Ronck, MD (SSM Health)	No disclosure on file
Eric Jaton, MD	No disclosure on file
	No disclosure on file
Kathryn Bard, PA	Ms. Bard has nothing to disclose.
Amelia Solei, NP	Mrs. Solei has nothing to disclose.
Apameh Salari, MD	Dr. Salari 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.

�鶹��ýӳ��

�鶹��ýӳ��

Abstract Details