To evaluate stroke code time metrics and frequency of rt-PA administration in emergency department (ED) stroke codes evaluated at bedside versus telemedicine.

Telemedicine allows for increased access to acute stroke care. Data must be examined regarding differences in stroke code time metrics and acute thrombolytic use in Hub bedside compared to Spoke telemedicine evaluations to optimize care. 

We retrospectively reviewed prospectively collected data from an IRB-approved registry. The sample included consecutive stroke code activations at an academic, Comprehensive Stroke Center evaluated at bedside (BG) compared to aggregate telemedicine sites (TG) from 10/1/2013-6/30/2020. We included all rt-PA treated patients. Providers were the same in both groups. We assessed 1) time from ED arrival to treatment decision, 2) ED arrival to rt-PA administration, and 3) treatment rates between groups. Groups were compared via chi-squared, logistic regression, t-test, and Pairwise Wilcoxon where appropriate. Analyses were unadjusted and adjusted for NIHSS as appropriate.

In total, 876 patients received rt-PA. There was no significant difference in patients receiving IV rt-PA only versus IV rt-PA and endovascular therapy between BG and TG (p=0.45). There was no significant difference in time from ED arrival to treatment decision between groups (x~BG 35.0 min vs TG 35.0 min; x¯BG: 35.3 min vs TG: 37.7 min; p=0.09). There was no significant difference in time from ED arrival to rt-PA administration between groups (x~BG 53.0 min vs TG 55.0 min; x¯BG: 57.2 min vs TG: 58.3 min; p=0.69). There was no difference in rt-PA treatment rates amongst the telemedicine spoke sites (p=0.45).

There were no significant differences in stroke code time metrics or rt-PA treatment rates in beside versus telemedicine stroke assessments in this study. Ensuring parity in stroke code evaluation is critical as telemedicine use increases due to the COVID-19 pandemic and its implication on the future of healthcare.