Telestroke Consultation in the Emergency Medical Services Unit: A Novel Approach to Improve Thrombolysis Times.

BACKGROUND: Faster treatment times are associated with improved outcomes in patients with acute ischemic stroke. In this prospective pilot study, we assess the feasibility of initiating telestroke consultation in emergency medical services unit (TEMS). METHODS: Patients with stroke symptoms were evaluated via TEMS using a video-call with a stroke provider. After TEMS evaluation, patients were transferred to the nearest stroke center (NSC) or thrombectomy capable center (TCS) depending on stroke severity and symptom onset time. We compared time metrics between patients evaluated via TEMS to those via standard telestroke (STS) consultation. RESULTS: 49 patients were evaluated via TEMS between May 2017 and March 2020. Median age was 66, 24 (49%) were females, 15 (30.6%) received intravenous alteplase (tPA) after arrival to a local hospital, and 3 (6.1%) underwent mechanical thrombectomy (MT) after bypassing the NSC. Compared to 52 tPA patients treated through STS consultation, TEMS patients had shorter door to needle (DTN) time (21 vs. 38 min, p < 0.001). In addition, patients who received MT after bypassing the NSC had shorter onset to groin time compared to those transferred from NSC (216 vs. 293 min, P = 0.04). CONCLUSION: Prehospital stroke triaging using TEMS is feasible, and could result in shorter DTN and onset to groin times.

Increased telestroke call burden after the extended thrombectomy window trials.

INTRODUCTION: Clinical trials have proven the efficacy of mechanical thrombectomy in stroke patients with large-vessel occlusion presenting within 24 hours of symptom onset. Extending the thrombectomy window to 24 hours resulted in a higher number of thrombectomies being performed. However, little is known about the impact of the extended thrombectomy window on the telestroke call burden. METHODS: We used the prospectively maintained database of a telestroke network covering a large geographic area in the Southeast USA. We included patients presenting between January 2015 and December 2019. We compared the characteristics and outcomes between patients who presented before and after the publication of the extended window thrombectomy trials. RESULTS: A total of 9041 patients presented with stroke-like symptoms during the study period. Of these, 4995 presented after February 2018. There was no difference in the patient demographics in both groups. However, patients in the post extended window group had a lower National Institute of Health Stroke Scale on presentation (3 vs. 4; p < 0.001) and longer symptom-onset-to-door time (124 vs. 85 minutes; p < 0.001). The number of consults per month nearly doubled (200 vs. 103; p < 0.001) in the extended thrombectomy window era. Similarly, the number of mechanical thrombectomies performed per month increased from four to seven since extending the thrombectomy window (p < 0.001). DISCUSSION: The number of telestroke consults nearly doubled after the publication of the extended thrombectomy window trials, with an increase in the number of thrombectomies performed. These findings have important operational implications for hospitals implementing telestroke call coverage.

Prevalence of congenital cardiovascular malformations varies by race and ethnicity.

BACKGROUND: Congenital cardiovascular malformations (CCVMs) are the most common forms of congenital defects, contributing to morbidity and mortality in neonates but information on the association of CCVMs and race is limited. This study aims to determine prevalence of congenital cardiovascular malformations (CCVMs) in the Hudson Valley Region (HVR) of NY State (NYS) by race and ethnicity. METHODS: NYS Department of Health Vital Statistics and Congenital Malformations Registry data were obtained by race and ethnicity (1992-2001) across the HVR. Live-birth cases that were diagnosed up to 2 years of age were included in year-of-birth registration. Prevalence was calculated using race/ethnic specific births. Poisson regression models, adjusting for number of live births by race, time and county, as specified were used for analysis. RESULTS: There were 3075 CCVMs of 2303 children from a birth population of 235,230. Overall prevalence of CCVMs was highest for Non-Hispanic White (NHW; 14.4/1000 live births) followed by Non-Hispanic Black (12.8/1000 live births), Others (12.5/1000 live births), and then Hispanics (8.8/1000 live births). Similarly, the risk ratio of all CCVMs was lowest for Hispanics. Hispanics had a lower risk as compared to NHW in each CCVM category except with hypoplastic left heart syndrome and patent ductus arteriosus. There were minimal temporal and regional differences. CONCLUSIONS: In the HVR, all CCVMs and specific anomalies have the highest prevalence in NHW with Hispanics consistently maintaining a lower risk.