The impact of teleneurologists on acute stroke care at an advanced primary stroke centre.

INTRODUCTION: We evaluated the impact of teleneurologists on the time to initiating acute stroke care versus traditional bedside neurologists at an advanced stroke center. METHODS: This observational study evaluated time to treatment for acute stroke patients at a single hospital, certified as an advanced primary stroke centre, with thrombectomy capabilities. Consecutive stroke alert patients between 1 March, 2016 and 31 March, 2018 were divided into two groups based on their neurology consultation service (bedside neurology: 1 March, 2016-28 February, 2017; teleneurology: 1 April, 2017-31 March, 2018). Door-to-tPA time and door-to-IR time for mechanical thrombectomy were compared between the two groups. RESULTS: Nine hundred and fifty-nine stroke patients met the inclusion criteria (436 bedside neurology, 523 teleneurology patients). There were no significant differences in sex, age, or stroke final diagnosis between groups (p > 0.05). 85 bedside neurology patients received tPA and 35 had mechanical thrombectomy, 84 and 44 for the teleneurology group respectively. Door-to-tPA time (median (IQR)) was significantly higher among teleneurology (64 min (51.5-83.5)) than bedside neurology patients (45 min (34-69); p < 0.0001). There was no difference in door-to-IR times (mean ± SD) between bedside neurology (87.2 ± 33.3 min) and teleneurology (90.4 ± 33.4 min; p = 0.67). DISCUSSION: At this facility, our teleneurology services vendor was associated with a statistically significant delay in tPA administration compared with bedside neurologists. There was no difference in door-to-IR times. Delays in tPA administration make it harder to meet acute stroke care guidelines and could worsen patient outcomes.

Prehospital Antibiotics Improve Morbidity and Mortality of Emergency Medical Service Patients with Sepsis.

Background: Severe sepsis is a major cause of mortality in patients evaluated in the Emergency Department (ED). Early initiation of antibiotic therapy and IV fluids in the ED is associated with improved outcomes. We investigated whether early administration of antibiotics in the prehospital setting improves outcomes in these patients with sepsis. Methods: This is a retrospective study comparing outcomes of patients meeting sepsis criteria in the field by EMS, who were treated with IV fluids and antibiotics. Their outcomes were compared with controls where fluids were administered prehospital and antibiotics were initiated in the ED. We compared morbidity and mortality between these groups. Results: Early antibiotics and fluids were demonstrated to show significant improvement in outcomes in the patients meeting sepsis criteria treated in the pre-hospital setting. The average age for sepsis patients receiving antibiotics in the prehospital setting was statistically higher than that for patients in the historical control group, 73.23 years and 67.67, respectively (p < 0.036), and there was no statistically significant difference of Charlson Comorbidity Index between the groups (p two-tail = 0.28). Average intensive care unit length of stay was 2.51 days in the in the prehospital group and 5.18 days in the historical controls, and the prehospital group received fewer blood products than the historical controls (p = 0.0003). Conclusions: Early IV administration of antibiotics in the field significantly improves outcome in EMS patients who meet sepsis criteria based on a modified qSOFA score.