Time to ramp up telestroke roll out


By Mardi Chapman

4 Mar 2021

There is now more evidence that telestroke capacity at hospital emergency departments can improve the rates of reperfusion and reduce mortality in patients presenting with acute ischaemic stroke.

A US study of more than 150,000 patients found those initially presenting at hospitals with telestroke capacity had reperfusion rates of 6.8% compared to 6.0% at hospitals without telestroke capacity (absolute difference, 0.78 percentage points; 95% CI, 0.54-1.03; p < .001).

“Compared with their matched controls, the risk ratios for treatment were higher for patients cared for at telestroke hospitals for any reperfusion treatment (risk ratio, 1.13; 95% CI, 1.09-1.17; P < .001), drip-and-ship cases (risk ratio, 1.38; 95% CI, 1.30-1.45; p < .001), and thrombectomies (risk ratio, 1.42; 95% CI, 1.25-1.62; p < .001).”

The 30-day mortality rates were 13.1% in patients presenting at hospital with telestroke capacity compared to 13.6% at other hospitals (difference, 0.50 percentage points; 95% CI, 0.17-0.83, p = .003).

“The risk ratios for postadmission mortality were 0.95 (95% CI, 0.92-0.99; p = .02) at 7 days, 0.96 (95% CI, 0.94-0.99; p = .003) at 30 days, 0.98 (95% CI, 0.96- 1.00; p = .04) at 90 days, and 0.98 (95% CI, 0.97-1.00; p = .09) at 180 days,” the study said.

There were no significant differences between the groups in outcomes such as returns to hospital or days living in the community post discharge.

The study, published in JAMA Neurology, found telestroke capacity had most impact in patients ≥85 years, rural patients, and at small, low stroke volume hospitals.

“Our findings are consistent with prior research that find an association between telestroke capacity and increased reperfusion treatment, although the increases we observed are more modest,” the researchers said.

“These more modest effects may be driven in part because we examined a more recent time period in which emergency medicine physicians have become more comfortable with thrombolysis and therefore may be more likely to use it without specialist consultation.”

The study also found the benefits of telestroke capacity did not result in higher institutional spending.

Australian context

Meanwhile, across Australia, implementation of telestroke programs has been patchy – well developed in Victoria, operating in Tasmania and South Australia, and still being rolled out in NSW and Western Australia.

The Stroke Foundation told the limbic there is no telestroke service in Queensland and the Northern Territory is supported by South Australia.

In its Federal Pre-Budget Submission 2021-22, the Foundation has called for a transition from state-based services to a national Australian Telestroke Network (ATN).

It says an ATN would ensure a more accessible, efficient and sustainable service.

Stroke Foundation Clinical Council Chair Professor Bruce Campbell said with the exception of Queensland, most states and territories now have pathways of care linking rural centres with comprehensive stroke centres in major cities, delivering best-practice treatment and care 24 hours a day, seven days a week.

“Stroke Foundation is advocating for the Federal Government to take the next step and support a national coordination of telestroke service delivery across the country. This would ensure all Australians have equal access to the evidence-based care and treatment that save lives and improve outcomes.”


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