Outcomes of Telestroke Inter-Hospital Transfers Among Intervention and Non-Intervention Patients

Background: Telestroke is an established telemedicine method of delivering emergency stroke care. However, not all neurological pa-tients utilizing telestroke service require emergency interventions or transfer to a comprehensive stroke center. To develop an understand-ing of the appropriateness of inter-hospital neurological transfers uti-lizing the telemedicine, our study aimed to assess the differences in outcomes of inter-hospital transfers utilizing the service in relation to the need for neurological interventions.Methods: The pragmatic, retrospective analysis included 181 con-secutive patients, who were emergently transferred from telestroke-affiliated regional medical centers between October 3, 2021, and May 3, 2022. In this exploratory study investigating the outcomes of telestroke-referred patients, patients receiving interventions were compared to those that did not following transfer to our tertiary center. Neurological interventions included mechanical thrombec-tomy (MT) and/or tissue plasminogen activator (tPA), craniectomy, electroencephalography (EEG), or external ventricular drain (EVD). Transfer mortality rate, discharge functional status defined by modi-fied Rankin scale (mRS), neurological status defined by National Institutes of Health Stroke Scale (NIHSS), 30-day unpreventable re-admission rate, 90-day clinical major adverse cardiovascular events (MACE), and 90-day mRS, and NIHSS were studied. We used chi 2 or Fisher exact tests to evaluate the association between the interven-tion and categorical or dichotomous variables. Continuous or ordinal measures were compared using Wilcoxon rank-sum tests. All tests of statistical significance were considered to be significant at P < 0.05.Results: Among the 181 transferred patients, 114 (63%) received neu-ro-intervention and 67 (37%) did not. The death rate during the index admission was not statistically significant between the intervention and non-intervention groups (P = 0.196). The discharge NIHSS and mRS were worse in the intervention compared to the non-intervention (P < 0.05 each, respectively). The 90-day mortality and cardiovascu-lar event rates were similar between intervention and non-interven-tion groups (P > 0.05 each, respectively). The 30-day readmission rates were also similar between the two groups (14% intervention vs. 13.4% non-intervention, P = 0.910). The 90-day mRS were not sig-nificantly different between intervention and non-intervention groups (median 3 (IQR: 1 -6) vs. 2 (IQR: 0 -6), P = 0.109). However, 90-day NIHSS was worse in the intervention compared to non-intervention group (median 2 (IQR: 0 -11) vs. 0 (IQR: 0 -3), P = 0.004).Conclusions: Telestroke is a valuable resource that expedites emer-gent neurological care via referral to a stroke center. However, not all transferred patients benefit from the transfer process. Future mul-ticenter studies are warranted to study the effects or appropriateness of telestroke networks, and to better understand the patient character-istics, resources allocation, and transferring institutions to improve telestroke care.