We hypothesize that imaging-to-needle time (ITN) is a more accurate metric for comparing telemedicine and in-person evaluation for acute stroke patients treated with thrombolytics.

This is a retrospective cohort study of 7-years of consecutive stroke patients treated with thrombolytics at Southern Illinois Healthcare Stroke Network. Data on demographics, clinical presentation, stroke metrics, thrombolytic complications, and mRS at 1 month were reviewed. Three distinct multivariate logistic regression models were applied to evaluate the predictors of DTN, ITN, and DIT, respectively, with odds ratios and 95% confidence intervals. P value was set at 0.05.

Out of 287 patients treated with thrombolytics, 170 were evaluated by telemedicine and 117 in-person. The two groups were comparable in demographics and stroke severity. Telemedicine had longer median DTN, in minutes (55[43-70] vs. 42[34-62], p<0.01), and median ITN, in minutes (43[35-58] vs. 32[25-48], p<0.01). There was no statistical difference in DIT between the two groups. In the regression models, adjusted for stroke severity and age, telemedicine was associated with lower odds of DTN <60 minutes (OR:0.553, 95%CI:0.328-0.931, p=0.026) and ITN <35 minutes (OR:0.265, 95%CI:0.159-0.441, p<0.01). However, telemedicine was not independently associated with DIT<25 minutes, which was instead correlated with age (OR:1.027, 95%CI:1.003-1.052, p=0.03). There were no differences in thrombolytic complications or outcome between the two groups.

Imaging-to-needle time represents a more accurate metric for comparing telemedicine and in-person evaluations than door-to-needle time, as it excludes stroke-specific processes of care and patient-specific factors that are intrinsic to door-to-imaging time and unrelated to the modality of evaluation.