Abstract TP402: Inpatient versus Emergency Department Code Stroke via Telemedicine

Introduction: Inpatient (IP) code strokes have been noted to have worse time metrics than code strokes in the Emergency Department (ED). Telemedicine (TM) has alleviated some disparities in management of acute ischemic stroke (AIS). We compared tPA time metrics between inpatient and ED code strokes via TM. Methods: We identified 681 AIS patients who received tPA in our Lone Star Stroke Consortium Telestroke Registry (LeSTER) from 1/2016-12/2017. There were 52 IP and 629 ED patients who underwent code strokes. We compared demographics and time metrics including TM page time to tPA (TPT) and CT scan time to tPA treatment (CTT), camera to tPA time (CAT), as well as post-tPA outcomes among the two groups using Wilcoxon rank sum test, Chi-square test, Fisher’s exact test, or logistic regression. Results: Inpatient strokes had delayed TPT compared to ED code strokes (44.5 vs. 38 minutes; p=0.007), longer CTT (56 vs. 46 minutes; p=0.003), longer CAT (34 vs. 29 minutes; p=0.010), but has a shorter time from last known well (LKW) to TPT (47 vs. 95.5 minutes; p<0.0001). Inpatient strokes were more severe (NIHSS 10 vs. 7; p=0.011). Pre-hospitalized patients were older (72 vs. 62; p<0.001). More inpatient stroke patients were sent to hospice or expired by discharge (17.3% vs. 7.3%; p=0.011) and less likely to be sent home (46% vs. 60.5%; p=0.044). Furthermore, inpatient strokes presented a higher mortality rate (28.2% vs. 12.7%; p=0.009) in the 90 day follow up. After adjusted for age and initial NIHSS, all the differences in the disposition and mortality rate are no longer significant. Conclusions: We found a significant delay in tPA metrics for inpatient code strokes as well as poorer clinical outcomes compared to patients who presented directly to the ED. Further investigation is needed to address gaps in the delivery of care to inpatients with suspected AIS via TM.