Improving stroke outcomes with telestroke
OA Version
Citation
Abstract
Stroke is the leading cause of chronic disability in the United States, leading to billions in rehabilitation and health care costs. While stroke is a broad term encompassing brain injury caused by ischemia, hemorrhage, venous thrombosis or aneurysm rupture, this review focuses largely on ischemic stroke. Modifiable stroke risk factors, such as hypertension, hyperlipidemia, and diabetes, are more likely to be adequately controlled in high income areas with greater access to health care.
Current management of acute stroke relies on prompt and accurate triage by EMS followed by high-quality, efficient Emergency Department care because acute treatment options, such as plasminogen activator (IV tPA) and mechanical thrombectomy, are time sensitive. In rural and/or resource poor areas, options for transport to a tertiary center for decision making and further management is limited. Consultation via telestroke has, thus, been proposed as a mechanism to improve the quality of care.
As telestroke requires a significant up-front financial investment, the feasibility in resource poor and remote areas is crucial to consider prior to implementation. The proposed research study will be conducted at two Kansas City, Missouri regional hospitals -- one with telestroke capabilities and one without. An investigation into the impact of telestroke on core stroke quality metrics of door-to-needle (DTN) time, access to mechanical thrombectomy, and functional outcome as measured by the modified Rankin scale (mRS) is proposed.