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Oral Presentation

(CS6-01) Time from Consult Page to Tissue Plasminogen Activator Treatment over Telestroke Decreases with Experience

Monday, April 24
11:30 AM - 11:59 AM
Location: W224 AB

Objectives
• Describe the importance of formal telestroke training for neurovascular fellows in the setting of growing gaps in acute ischemic stroke coverage, and in spite of lack of well-characterized educational approaches.
• Compare tissue plasminogen activator treatment metrics between neurovascular fellows and neurovascular attendings for acute ischemic stroke patients, using the time between when a telestroke consultant is paged and the time of tissue plasminogen activator administration (page-to-needle time) as an objective measure of proficiency in telestroke management of acute ischemic stroke.
• Recognize trends in page-to-needle time with increasing number of telestroke consultations for both neurovascular fellows and neurovascular attendings.

Methods
From 7/2013 to 12/2015, we identified suspected acute ischemic stroke patients in our telestroke registry who received tissue plasminogen activator while being evaluated remotely by video consultation at one of 17 spokes in our telestroke network. Using multivariable quantile regression, we estimated the difference, and 95% confidence interval (CI) of the difference, for median page-to-needle time between neurovascular fellows and neurovascular attendings. We also report the coefficient of change in page-to-needle time over increasing number of telestroke consults.

Results
Neurovascular fellows evaluated 53.7% of 618 acute ischemic stroke cases in which tissue plasminogen activator was administered over telestroke. Neurovascular attendings took less time to administer tissue plasminogen activator, with a difference in median page-to-needle time (95% CI) of -9 minutes (-12.3 to -5.7). This difference persisted when adjusted for relative contraindications to tissue plasminogen activator. For each additional telestroke consult, page-to-needle time was decreased by 0.07 minutes for neurovascular fellows or neurovascular attendings (p=0.02 and < 0.01, respectively).

Conclusion
Time to administration of tissue plasminogen activator improved with increasing number of telestroke consults for neurovascular fellows and for neurovascular attendings. Page-to-needle time improves by 1 minute for approximately every 14 telestroke consults. Our findings support the importance of integrating telestroke training into a supervised neurovascular fellowship to increase neurovascular fellow proficiency in telestroke prior to independent practice.

Amanda L. Jagolino-Cole

Assistant Professor
University of Texas Health Science Center at Houston, McGovern Medical School

Dr. Amanda Jagolino-Cole majored in Biochemistry at the University of Pennsylvania, then taught English and health education in the Peace Corps in Ukraine. She graduated from Jefferson Medical College in Philadelphia. She trained in Neurology at the University of Miami/Jackson Memorial Hospital, where she served as Chief Resident. She first became interested in expanding emergency stroke care to underserved populations while completing Vascular Neurology fellowship at the University of Texas Medical School at Houston. There, as Assistant Professor of Neurology, her research focuses on characterizing and improving the role of telemedicine in providing advanced acute stroke care to other communities.

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Shima Bozorgui

Research Assistant II
The University of Texas Health Science Center at Houston

Dr. Shima Bozorgui is a Research Assistant II in the Department of Neurology at The University of Texas Health Science Center at Houston, McGovern Medical School. She got her MD degree from Tehran University of Medical Sciences (TUMS) and after graduation she practiced as a physician for two years. She worked as a medical officer and the head of a medical team in an urban public health center in an underserved area. She also holds MPH degree in Epidemiology from The University of Texas Health Science Center at Houston. She worked as a research volunteer at Baylor St. Luke's Medical Center, Department of Internal Medicine mainly on two prospective observational studies on Clostridium Difficile Associated Diarrhea (CDAD). Currently she is collaborating in preparing the Lone Star Stroke Consortium TeleStroke Registry (LESTER) via collecting data on all telemedicine treated stroke patients throughout the Texas Lone Star network.

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Arvind Bambhroliya

Sr Research Assistant
University of Texas Health Science Center at Houston

Dr. Arvind Bambhroliya is a Senior Research Assistant in the Department of Neurology at The University of Texas Health Science Center at Houston. He holds an MBBS degree from The Maharaja Sayajirao University of Baroda, an MPH and MS degree from The University of Texas Health Science Center at Houston. He has over 5 years of research experience working on multiple epidemiological and biomedical research projects and is a recipient of the M. D. Anderson Alumni and Faculty Association Graduate Student Award in Population/Patient-Oriented Research (first place). He is extremely interested in learning and applying everything that matters in bringing science from the bench to the clinic.

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TC Cossey

Assistant Professor of Neurology
University of Texas Health Science Center

Dr. TC Cossey majored in Biological Anthropology and Anatomy at Duke University, then graduated from the University of Alabama at Birmingham School of Medicine. She trained in Neurology at Barrow Neurological Institute in Phoenix, Arizona, where she served as Chief Resident. Dr. Cossey completed a Vascular Neurology fellowship at the University of Texas at Houston, and joined faculty as Assistant Professor of Neurology. Her research interests include optimizing treatments of acute stroke, and using telemedicine to improve access to stroke care for underserved populations.

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Alyssa D. Trevino

Research Coordinator
UTHealth

Alyssa Trevino is a Research Coordinator in the Department of Neurology at The McGovern Medical School. She holds a Bachelor’s degree from St. Mary’s University, majoring in Biology, and has over 2 years of clinical research experience in Phase 1 clinical trials. Alyssa is extremely passionate working in clinical research and continues to seek new beneficial and feasible ways to assist patients living a healthy, productive life.

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Sean I. Savitz

Frank M. Yatsu Chair and Professor of Neurology
The University of Texas Health Science Center at Houston, McGovern Medical School

Sean I. Savitz, MD is a tenured Professor of Neurology, holds the Frank M. Yatsu Chair in Neurology, and directs the Stroke Program at the University of Texas Medical School in Houston. He graduated from Harvard College, received his MD from Albert Einstein College of Medicine, and completed neurology residency training and a cerebrovascular fellowship at the Harvard Medical School Neurology Training Program. He and his team run one of the largest academic stroke programs in the world, testing novel treatments for patients with ischemic stroke and brain hemorrhage. Dr. Savitz oversees a bidirectional, translational laboratory and clinical research program on cell therapies in stroke and is conducting some of the first clinical trials testing cell therapies in stroke patients.

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Tzu-Ching Wu

Assistant Professor of Neurology
UTHealth -- The University of Texas Health Science Center at Houston

Dr Teddy Wu received his medical degree from the University of Maryland in Baltimore, MD. From there, he did his neurology residency at Barrow Neurological Institute in Phoenix, AZ, and completed a two-year vascular neurology fellowship with the University of Texas Medical School at Houston world-renown stroke team. His research and clinical interests focus on development of new technologies that will enhance delivery of acute stroke care. As the director of the Mischer Neuroscience Institute Telemedicine Network, he directs and participates in the team that provides over 1300 acute neurological consultations per year, including over 200 IV-t-PA treated patients annually. He is also heavily interested in utilizing mobile technology and will be recently conducted a pilot trial using mobile telemedicine in ambulance to help accurately triage patients with acute stroke.

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Farhaan Vahidy

Assistant Professor
The University of Texas Health Science Center at Houston, McGovern Medical School

Dr. Farhaan Vahidy graduated medical school in 1996 and did a general medicine and emergency medicine residency. For about 12 years he practiced emergency medicine and field medicine as a military physician. He also trained and worked as a flight surgeon with the Air Force. Later he completed my Masters in Public Health, following which he taught courses in epidemiology and biostatistics to MPH and BSN students. His earlier research was in epidemiology of non-communicable diseases like depression and cardio-vascular diseases in developing countries. He completed his doctoral research degree (PhD) from University of Texas School of Public Health in epidemiology and biostatistics. His research interests are epidemiology and primary and secondary prevention of stroke, stroke recovery, and health systems research for stroke care delivery.

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Christy M. Ankrom

Program Manager, Research Manager
University of Texas Health Science Center at Houston, McGovern Medical School

Christy Ankrom has been with The University of Texas Health Science Center at Houston (UTHSCH) Department of Neurology since 2002. She earned a Bachelor of Science degree from the University of Houston – Clear Lake. She is the program manager of the UTHSCH regional teleneurology network, and the research manager of the Houston hub of the Lone Star Stroke Research Consortium, funded by the Texas Department of State Health Services.

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