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Teleneurocritical Care for Patients with Large Vessel Occlusive Ischemic Stroke Treated by Thrombectomy

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Abstract

Background

Teleneurocritical care (TNCC) provides 24/7 virtual treatment of patients with neurological disease in the emergency department or intensive care unit. However, it is not known if TNCC is safe, effective, or associated with similar outcomes compared with in-person neurocritical care. We aim to determine the effect of daily inpatient consults from TNCC on the outcomes of patients with large vessel occlusive acute ischemic stroke treated by thrombectomy.

Methods

A multicenter, retrospective cohort of consecutive patients ≥ 18 years old with acute ischemic stroke from a large vessel occlusion treated by thrombectomy were identified from 2018 to 2021 within a telehealth network of an integrated not-for-profit health care system in the United States. The primary end point was good functional outcome, i.e., modified Rankin Scale 0–3, at the time of hospital discharge in patients receiving in-person neurocritical care versus TNCC.

Results

A total of 437 patients met inclusion criteria, 226 at the in-person hospital (median age 67, 53% women) and 211 at the two TNCC hospitals (median age 74, 49% women). The rate of successful endovascular therapy (modified Thrombolysis in Cerebral Infarction score 2b–3) was not different among hospitals. Good functional outcome at discharge was similar between in-person neurocritical care and TNCC (in-person 31.4% vs. TNCC 33.5%, odds ratio 0.88, 95% confidence interval 0.6–1.3; p = 0.64). Only National Institutes of Health stroke scale and age were multivariable predictors of outcome. There were no differences in mortality (9.3% vs. 13.2%, p = 0.19), intensive care unit length of stay (2.1 vs. 1.9 days, p = 0.39), or rate of symptomatic intracerebral hemorrhage (6.8% vs. 6.6%, p = 0.47) between in-person neurocritical care and TNCC.

Conclusions

Teleneurocritical care allows for equivalent favorable functional outcomes compared with in-person neurocritical care for patients with acute large vessel ischemic stroke receiving thrombectomy. The standardized protocols used by TNCC in this study, specifically the comprehensive 24/7 treatment of patients in the intensive care unit for the length of their stay, may be relevant for other health systems with limited in-person resources; however, additional study is required.

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Funding

There were no funding sources for this study.

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Authors and Affiliations

  1. Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA

    Nick M. Murray, Scott Marshall, Robert Hoesch, Kyle Hobbs, Shawn Smith, Dean Roller, Katherine Thomas, Kevin Meier & Adrian Puttgen

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  1. Nick M. Murray
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  2. Scott Marshall
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  3. Robert Hoesch
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  4. Kyle Hobbs
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  9. Adrian Puttgen
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Contributions

NMM, KH, SS, SM, DR, KT, KM, RH, and AP developed the conceptual idea for the article and edited and revised its final versions. NMM wrote and edited the initial drafts of the article. The final manuscript was approved by all authors.

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Correspondence to Nick M. Murray.

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Adherence confirmed to ethical guidelines, this is an institutional review board–approved study.

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Murray, N.M., Marshall, S., Hoesch, R. et al. Teleneurocritical Care for Patients with Large Vessel Occlusive Ischemic Stroke Treated by Thrombectomy. Neurocrit Care 38, 650–656 (2023). https://doi.org/10.1007/s12028-022-01632-x

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  • DOI: https://doi.org/10.1007/s12028-022-01632-x

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