Azima Shaji1, Tamia Garrett1, Tia Lal1, Sushanth Aroor1, Ieshia Deal1, Sunita Devi2, Areeba Memon2, Abigail Betner1, Charles Green1, Sishir Mannava1, Amanda Jagolino-Cole1
1University of Texas Health Science Center At Houston, 2Baptist Hospital of Southeast Texas
Objective:
To review the relationship between pre-admission tele-stroke triage modalities - tele-stroke video consultation (TVC), tele-stroke phone consultation (TPC), or no tele-stroke consultation (NTC) - and its influence on hospital outcomes
Background:
Tele-stroke video consultation facilitates thrombolytic decisions in acute care. Less is understood regarding acute tele-stroke triage and inpatient hospital metrics after admission.
Design/Methods:
We retrospectively reviewed routine inpatient stroke consultations (12/2022-7/2023) managed remotely in our tele-neurology network, and whether cases were preceded by TVC, TPC, or NTC. We excluded inpatient tele-stroke codes, thrombolytic cases, and patients transferred from the emergency department. We compared metrics including length of stay (LOS), transfer after admission (TAA), 30-day readmission, and discharge disposition among groups, controlling for age, race, ethnicity, gender, and insurance status. Stroke severity and premorbid functional status were captured regularly only in the TVC group
Results:
Of 322 cases, 15 underwent an inpatient code and 17 received thrombolytic. Of the remaining 290 patients, 202 (70%) had NTC, 47 (16%) were triaged by TPC, 41 (14%) by TVC. They had comparable age, gender, stroke risk factors, and payment source, without differences in ethnicity and race. Thirty-five patients had large vessel occlusion (11%), the majority found in NTC cases (20) after admission, although this was not significantly different (p=0.304). Patients had comparable discharge dispositions among groups (p=0.099). TAA occurred rarely with TPC (4%) and NTC (2%) but none after TVC (p=0.419). Readmission also occurred comparably frequently among TPC, NTC, and TVC (12%, 13%, and 10%, respectively, p=0.918). Median LOS was not significantly different among TPC, NTC, and TVC (4.5, 4, and 4 days, respectively, p=0.674). Propensity score matching revealed no significant difference in mean LOS or readmission, adjusting for age, gender, race, ethnicity, and vascular risk factors.
Conclusions:
Pre-admission acute triage modalities did not influence hospital outcomes nor discharge. Larger, multi-network studies are needed to understand inpatient tele-stroke metrics.