Abstract 3107: Thrombolysis Using Telehealth Has Comparable Results To Non- Telehealth Thrombolysis Across Northern Alberta: The Alberta Provincial Stroke Strategy (APSS)
Authors: Jeerakathil Thomas , Shuaib Ashfaq , Fang Shoufan , Butcher Kenneth , Saqqur Maher , Burridge Dorothy , Green Teri , Amlani Shy , Thompson Gayle , Hill Michael D , Khan Khurshid 
Published: July 2021

Background:
Telehealth videoconference technology shows promise in reducing rural-urban disparities in access to acute stroke care but more population-based studies are needed. The APSS has created a province-wide telehealth network (telestroke) centred around northern (University of Alberta Hospital) and southern (University of Calgary) tertiary care hub centres. In the northern half of the province we assessed the hypothesis that thrombolysis outcomes for stroke patients were similar in those treated using telestroke versus those treated without telestroke.

Methods:
The APSS created a prospective minimum dataset in June 2007 requiring submission of data for all ischemic stroke patients treated with tPA in the province. This dataset captures information on onset, arrival, and treatment times, whether telehealth was used, and occurrence of intracerebral hemorrhage associated with neurological worsening. From 2009 on we were able to differentiate post tPA petechial hemorrhage from intracerebral hematoma (ICH) in the database. Data were available for the northern half of the province. We examined door-to-treatment time using Wilcoxan rank - sum tests, and rate of neurological worsening associated with hemorrhage on brain CT using logistic regression.

Results:
In the northern half of the province, there were a total of 554 patients treated with tPA from 2007/08 until 2010/11. Telestroke was utilized in 119 of these (21%) from 9 rural Primary Stroke Centres. Of 435 patients who received tPA without telestroke, 318 (73%) were from one Comprehensive Stroke Centre and 117 (27%) were from three Primary Stroke Centres with neurologists or internists on-site. Telestroke patients had a mean age of 70y compared to 71y for non-telestroke patients. Median (Q1, Q3) door to needle time was 84 min (66, 105) in telestroke patients and 83 min (65, 107) in non-telestroke patients (p=0.337). Neurological worsening associated with either petechial hemorrhage or intracerebral hematoma by 36 hours occurred in 5.29% of non-telestroke patients and 8.4% of telestroke patients; this difference was not statistically significant (OR 0.608; p=0.207). The rate of neurological worsening associated with intracerebral hematoma was 3.0% to 7.9% for telestroke patients and 3.6% to 5.6% for non-telestroke patients when we examined 2009-10 and 2010-11 (OR 0.814; p= 0.732).

Conclusion:
With one hub centre it is feasible to create a telehealth network over a very large geographic area improving access to stroke care for remote rural communities. Door-to-treatment time and rate of hemorrhagic complications are comparable in telestroke-treated versus non telestroke-treated patients in real practice. Investment in telestroke is likely justified for health regions serving a large and scattered rural population.