(345) Effect of Teleneurology on Door-to-Needle Times for Tenecteplase in Acute Ischemic Stroke

Introduction: Intravenous thrombolysis remains the primary treatment for acute ischemic stroke (AIS); however, administration is time sensitive. Teleneurology services have increased in popularity in recent years due to their ability to aid in triaging patients with neurological conditions. Teleneurology services were implemented at Morton Plant Hospital, a comprehensive stroke center, in August 2023 to aid in streamlining the administration of tenecteplase (TNK) in AIS patients. Currently, there are no studies assessing whether the implementation of teleneurology services at a comprehensive stroke center influences TNK door-to-needle (DTN) time. The purpose of this study is to evaluate the difference in DTN times when TNK is administered with versus without a teleneurology consult.

Methods: This was a single center, institutional review board approved, retrospective cohort study including adult patients who presented to Morton Plant Hospital’s Emergency Department between January 1st, 2022 and April 1st, 2023 and received TNK for the treatment of AIS. The primary outcome was DTN time, defined as the moment the patient first enters the door of the emergency department to the moment the IV bolus of fibrinolytic is administered. Secondary outcomes included the proportion of patients with DTN time within 45 minutes, neurological improvement at 24 hours and discharge, and rate of hemorrhagic conversion.

Results: A total of 93 patients were included with 50 patients in the teleneurology group and 43 patients in the standard group. Baseline characteristics were comparable between both treatment groups. The median DTN time was significantly reduced in the teleneurology group (34.5 [IQR, 23.8-43] vs 49 [IQR, 40-70] minutes, p< 0.01). For secondary outcomes, the teleneurology group had more patients with a DTN time within 45 minutes (40 vs 19, p < 0.01). There was no significant difference in early neurological improvement (27 vs 25), neurological improvement at discharge (31 vs 26), or hemorrhagic conversion (6 vs 3).

Conclusions: Among patients who received TNK for the treatment of AIS, there was a significant reduction in DTN time with the use of teleneurology services. There was no difference in neurological improvement or rate of hemorrhagic conversion.