Clinical Services

Facilitated Roundtable Discussion

CS2-13 - Symptomatic Intracerebral Hemorrhage Related to tPA Administered over Tele Stroke Within 4.5-hour Window

Tuesday, May 1
11:35 AM - 12:00 PM
Location: Education Zone, Booth 2416, Zone 3

Introduction: Intravenous alteplase (tPA) remains the cornerstone medical treatment for acute ischemic stroke. Standard of care guidelines have expanded, from the prior guideline of 3 hours, to allow tPA administration within 4.5 hours of stroke onset. Symptomatic intracerebral hemorrhage (sICH) is one of the most serious complications of stroke treatment. The establishment of telestroke technology has allowed patients presenting to hospitals that lack expert stroke care to be evaluated and receive tPA. The safety of tPA administered through telestroke has been evaluated only when tPA is given within the 3-hour window of last known normal.

Methods: A retrospective analysis on the prospectively collected database for all patients that received tPA at the Medical University of South Carolina Comprehensive Stroke Center (MUSC) (hub), as well as the MUSC telestroke network partner hospitals (spokes) was performed. Collected data included demographics, baseline characteristics, time from last known well to tPA administration, door-to-needle times, and symptomatic intracerebral hemorrhage rates. Logistic regression was used to examine the odds of a symptomatic intracerebral hemorrhage (sICH) in patients at spoke sites compared to the hub controlling for patient demographics and stroke severity.

Results: A total of 816 patients were identified. The sample includes 564 patients administered tPA via telestroke services at the spoke sites and 252 at the hub. Median NIHSS was significantly higher among patients treated at the hub (9 vs 8, P=0.022), otherwise baseline characteristics were similar in both treatment groups. The door to needle times improved overtime in both groups. By 2016 both the spoke and the hub averaged door-to-needle (DTN) times within the 60-minute guideline. However, DTN times remain lower in the hub site (42 minutes) compared to the spokes (59 minutes). Symptomatic intracerebral hemorrhage (sICH) occurred in 26 (4.61%) in the spoke group and 10 (3.97%) in the hub group (P=0.68). Logistic regression results found no significant difference in the odds of sICH if tPA is given in a spoke site and no differences in adverse outcomes with tPA administration 0-179 minutes versus 180-270 minutes from last known normal time (p=0.308).

Conclusion:
Our study shows that intravenous tPA when administered at spoke hospitals through telestroke consultations within the 4.5-hour window does not increase the odds of sICH compared to administration at hub hospitals.

Learning Objectives:

Jillian B. Harvey

Assistant Professor
Medical University of South Carolina

Jillian Harvey is an Assistant Professor in Healthcare Leadership and Management at the Medical University of South Carolina and the Director for the Doctor of Health Administration Division. She received a Master of Public Health from Oregon State University and a PhD in Health Policy and Administration from the Pennsylvania State University. Her research experience includes program evaluation, healthcare quality improvement, and mixed methods research approaches. Her current research focuses on evaluating the development and implementation of telehealth programs and the impact on healthcare outcomes.

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Ellen Debenham

Manager Telehealth Clinical Services
Medical University of South Carolina

Ellen Debenham is the Manager of Clinical Services in the Center for Tele Health at the Medical University of South Carolina (MUSC). She started the tele stoke program at MUSC in 2008. The program has completed over 12,000 consults and includes 26 partner hospitals. The neuroscience program has expanded to include tele EEG and scheduled and acute neurology consults.

Presentation(s):

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Christine Holmstedt

Medical Director, Telestroke Program
Medical University of South Carolina

Dr. Holmstedt is Medical Director for the MUSC Telestroke program.

Presentation(s):

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