Objective:

We sought to study patient characteristics and 90-day clinical outcomes among telestroke transfers and compared characteristics between the patients who received stroke interventions of tPA +/- thrombectomy versus who did not.

Background:

Telestroke programs are crucial in providing access to regional medical centers that may not have direct in-person neurology. Patients who get emergently transferred to an affiliated tertiary medical center after an acute telestroke evaluation may not end up requiring advanced tertiary care, which raises a question of  potentially futile transfer.

Design/Methods:

We retrospectively analyzed 204 consecutive emergent telestroke transfers from affiliated 19 regional medical centers  between October 3rd, 2021, to May 3rd, 2022. The primary outcome of interest was 90-day clinical outcome and  30-day readmission. Baseline patient characteristics were compared. 

Results:

Among total 204 patients (mean age 64, female [51.0%]), 181 (88.7%) cases had initial transfer request to our ER and 126 (61.8%) cases were eventually admitted to the ICU. A total of 72 (35.3%) patients underwent an intervention. There was a significant difference in patients age (68 vs 62, P<0.05), acuity of care (i.e., ICU admission, 78% vs. 53%, P<0.001), stroke diagnosis (ischemic stroke, 93% vs. 25%; hemorrhagic stroke 4% vs 43%; P<0.001), neurosurgery consult (8.3% vs. 43.2%, P<0.001), presenting NIHSS (13 vs 7, P<0.001) in patients with or without intervention, respectively. The 90-day death outcome or 30-day readmission were similar between the two groups of intervention versus without intervention (P>0.05). There were no differences in length of stay or death during index admission in these 2 groups (P>0.05). Goals of care discussions prior to transfer were unclear for both groups, and majority of these two groups were labeled as full code (P>0.05).

Conclusions:

There are patients that do not require interventions, yet require transfer after tele-stroke evaluations, requiring additional resources. Future studies are warranted to understand preventable and unnecessary transfers.