Telestroke and Timely Treatment and Outcomes in Patients With Acute Ischemic Stroke

作者：Brian Stamm, Rachael T. Whitney, Regina Royan, Ghada Ibrahim, Adrienne Nickles, Rebecca Ferber, Wen Ye, Wan-Ling Hsu, Nikita Chhabra, Rodney A. Hayward, Mollie McDermott, Phillip Scott, Kevin N. Sheth, Mathew J. Reeves, Deborah A. Levine · 发表于：JAMA Network Open · 年份：2025 · DOI：10.1001/jamanetworkopen.2025.34275 · 被引用次数：7 · 研究领域：Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery、Traumatic Brain Injury and Neurovascular Disturbances

Importance: Telestroke has the potential to revolutionize acute stroke treatment by improving access to optimal stroke care, including time-sensitive care such as thrombolysis. However, it is unclear how treatment times and stroke outcomes compare between patients evaluated and not evaluated by telestroke. Objective: To evaluate the association between telestroke use and acute stroke treatment times and outcomes. Design, Setting, and Participants: This retrospective cohort study included patients with acute ischemic stroke aged 18 years or older presenting to 42 Paul Coverdell Michigan Stroke Registry hospitals from January 1, 2022, to December 31, 2023. All patients were potentially eligible for thrombolysis (ie, presented ≤4 hours of last known well, no contraindications to thrombolysis documented). Exposure: Telestroke (vs nontelestroke) encounter. Main Outcomes and Measures: The primary outcomes were receipt of thrombolysis and door-to-needle (DTN) time as a continuous variable and a categorical variable (≤60 vs >60 minutes). Secondary outcomes included discharge ambulatory status, discharge destination, and door-in-door-out (DIDO) time in transferred patients. Multivariable hierarchical models evaluated associations between telestroke (vs nontelestroke) activation and outcomes, sequentially adjusting for demographics, medical history, presentation or arrival, and hospital characteristics. Results: Among the 3036 patients with acute ischemic stroke potentially eligible fo...