Background: A telestroke service has been established in the Central Region of Aotearoa since 2016, whereby Wellington-based neurologists perform hyper-acute stroke assessments via video conferencing for patients presenting to eight regional hospitals. On the 1st of July 2022, telestroke pathways were changed, so that the neurologist was notified after neuroimaging, rather than before.
Aims: The study’s aim was to assess the impact of the change in the telestroke notification on reperfusion treatment metrics.
Methods: A retrospective audit of prospectively collected data as part of the REDCap telestroke database was conducted comparing the six months prior to and following the change. The primary outcome measures were reperfusion rates and door-to needle times. Secondary outcomes included door-in-door-out time and percentage of calls which resulted in reperfusion therapy. Wilcoxen rank sum test was used.
Results: The reperfusion numbers were similar in the pre-imaging notification (86) and post-imaging (91) study periods. Time metrics were similar: door-to-needle (median 65 (IQR 52-87) vs 63.5 (59-92); p=0.88); door-to-CT (median 29 (18-37) vs 26 (20-41); p=0.51), and CT-to-needle (34 (29-53) vs 33 (30-56); p=0.51). Thrombolysis rates by telestroke alerts were similar pre-imaging 105/351 (29.9%) and post-imaging 109/390 (27.9%). For clot retrieval patients, the door-in-door-out and number of telestroke alert median was unchanged (160mins (IQR 110-173) vs 164mins (109-180); 360-358 minutes respectively; p=0.56). This data does not account for temporal trends, a potential confounder.
Conclusion: These finding suggest that the change in notification did not negatively affect reperfusion treatment metrics, and post-imaging notification appears to represent a safe alternative to early notification in the Central Region of Aotearoa.