To determine if there are differences between door-to-needle times and 90-day modified Rankin scores (mRS) among patients administered tPA via telestroke at hospitals with a primary stroke center (PSC) designation versus those who had not.

Telestroke visits that resulted in tPA administration coordinated by a tertiary care center were analyzed from 1/1/16-9/24/17 via retrospective chart review. Hospitals receiving telestroke services were designated as PSC if accredited by the Joint Commission or Det Norske Veritas-Germanischer Lloyd. Logistic regression was used to analyze the association between receiving tPA at a PSC and mRS ≤2 after 90 days.

In total, 428 patients received tPA over 23 sites. 270 of these were seen at a PSC, while 158 were seen at other hospitals (nPSC). Samples differed in the proportion of whites (72.6% at PSC, 56.3% at nPSC; p<0.001), patients with prior stroke (17.1% at PSC, 25.3% at nPSC; p=0.04) and mean admission NIHSS (9.2 at PSC, 11 at nPSC; p=0.02). Fewer patients were transferred for further care at PSC (40.7% vs 73.4% at nPSC, p<0.001). There was no significant difference of the odds of mRS ≤2 between PSC and nPSC (OR 1.20, 95% CI 0.79-1.83). Odds of mRS ≤2 after adjustment for age, race, gender, NIHSS, hospital transfer, stroke history, and atrial fibrillation were not significant (OR 0.88, 95% CI 0.50-1.54). Mean door to needle times differed significantly (57 minutes at PSC, 65 minutes at nPSC; p<0.001).

Although patients seen at a PSC received tPA at significantly shorter door to needle times, adjusted 90 day mRS scores were not significantly different. This suggests that telestroke can help equalize outcomes over a wide range of hospitals.