ABSTRACT
Objective: To compare conventional, inpatient acute ischemic stroke (AIS) care with telestroke inpatient AIS care at a comprehensive stroke center (CSC). Background: The COVID-19 pandemic disrupted specialist stroke care. New barriers to healthcare delivery including physical distancing, personal protective equipment shortages, and provider illness may be surmountable through telemedicine, however, the efficacy of telestroke for inpatient management of AIS patients at CSCs is unknown. Design/Methods: TELECAST-CSC is a pre-post study examining AIS care at a single CSC. All patients with a clinical or radiographic diagnosis of AIS were included. In the first phase (December 1, 2019-March 15, 2020), all inpatient stroke specialist care was delivered conventionally in-person;in the second phase (March 16, 2020-June 29, 2020) all inpatient stroke specialist care was delivered via telestroke. The primary outcome was the composite adherence rate to AHA guidelines for inpatient AIS care. Secondary outcomes were adherence rates for subcategories of the primary outcome and 30- and 90-day rates of readmission and recurrent cerebrovascular events. Results: One hundred forty-four patients were included in the “in-person” cohort and 141 patients in the “telestroke” cohort (overall median age 72 [IQR 61-82], median NIHSS 2 [IQR 0- 8], 17.2% received thrombolysis, 10.2% received thrombectomy). There was no difference in adherence AHA guidelines for inpatient AIS care between the in-person and telestroke cohorts (96.9% vs 96.3%, p=0.26), or any subcategories of the primary outcome. There was no difference in readmission rates within 30 days (11.8%, vs. 13.5%, p>0.999) and 90-days (18.8% vs 19.2%, p>0.999) or rates of recurrent stroke within 30 days (2.1% vs 2.1%, p>0.999) and 90 days (3.5% vs. 3.6%, p>0.999) for the in-person and telestroke cohorts, respectively. Conclusions: At an academic CSC adherence to AHA guidelines for inpatient AIS were similar when care was delivered in-person or exclusively via telestroke, without differences in recurrent stroke or readmission rates between cohorts.