AUTHOR=Choi Justin , Petrone Ashley , Adcock Amelia 

TITLE=A Case for the Non-Neurologist Telestroke Provider

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.651519

DOI=10.3389/fneur.2021.651519

ISSN=1664-2295

ABSTRACT=Introduction: Telestroke networks have effectively increased the number of ischemic stroke patients who have access to acute stroke therapy. However, the availability of a dedicated group of stroke subspecialists is not always feasible. We hypothesize that rates of tPA recommendation, sensitivity of final diagnosis and post-tPA hemorrhagic complications do not differ significantly between neurologists and an emergency-medicine physician during telestroke consultations.

Methods: Retrospective review of all telestroke consults performed at a comprehensive stroke center over one year. Statistical analysis: Chi squared test.

Results: 303 consults were performed among 6 spoke sites. Overall rate of tPA recommendation was 40%, 38%, 41%, and 41% among the all neurology-trained, emergency medicine-trained, stroke neurology-trained and other neurology-trained provider groups respectively (p = .427). Sensitivity of final stroke diagnosis was 77% and 72% in the emergency-medicine trained and neurology-trained groups (p = 0.777) No symptomatic hemorrhagic complications following the administration of tPA via telestroke consultation occurred in any group over this time period.

Discussion/Conclusion: Our results did not illustrate any statistically significant difference between care provided by an emergency medicine physician and neurologists during telestroke consultation. While our study is limited by its low numbers, it suggests that identifying a non-neurologist provider who has clinical experience with acute stroke patients can safely and appropriately provide telestroke consultation. The lack of formerly trained neurologists, therefore, may not need to serve as an impediment to building an effective telestroke network. Future efforts should be focused on illuminating all strategies that facilitate sustainable telestroke implementation.