Open AccessExpanding Acute Stroke Care in Rural America: A Model for Statewide Success
Author(s) -
Amelia Adcock,
Justin Choi,
Muhammad Alvi,
Ann Murray,
Eric Seachrist,
Matthew Smith,
Scott Findley
Publication year - 2020
Publication title -
telemedicine and e-health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.951
H-Index - 73
eISSN - 1556-3669
pISSN - 1530-5627
DOI - 10.1089/tmj.2019.0087
Subject(s) - medicine , stroke (engine) , emergency medicine , acute stroke , tissue plasminogen activator , medical emergency , mechanical engineering , engineering
Background: The state of West Virginia (WV) is often seen as a health care desert with a scarcity of hospitals and resources. The prevalence of cerebrovascular disease and associated comorbidities are also some of the highest in the nation. Introduction: Ischemic stroke is a time-sensitive diagnosis. Prompt treatment in WV is difficult due to limited and isolated stroke-ready hospitals. Adoption of telestroke has helped to bypass these obstacles and improve access to care. Materials and Methods: Retrospective analyses; using data from the American Heart Association's Get With The Guidelines Stroke Data Registry, and other statewide agencies, we looked for trends in the volume of patients treated with intravenous-tissue plasminogen activator (tPA) in WV. We also reviewed data from West Virginia University's (WVU) telestroke database to assess trends in consult volumes and quality metrics. Results: Since the establishment of WVU telestroke, the total number of stroke patients receiving tPA across the state increased by 173% from 2015 (259 patients) to 2018 (448 patients) (p < 0.0001). Telestroke consults made up 24% (107/448) of total statewide tPA administrations for 2018. Between 2016 and 2018, the total symptomatic hemorrhage rate for tPA treated patients through telestroke was 1% (3/292). Telestroke also facilitated local care by avoiding patient transfer on average 65% of the time. Conclusion: Not only has telestroke increased the quantity of treated acute ischemic strokes, but it has also done so safely and effectively even in resource-poor areas. These findings demonstrate that telestroke is a useful tool for treating strokes, particularly those that happen far from stroke centers.