J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 15, Number 6, June 2023, pages 292-299

Outcomes of Telestroke Inter-Hospital Transfers Among Intervention and Non-Intervention Patients

**Table 1.** Demographic and Characteristic Information of Patients With and Without Intervention
	No intervention (n = 67), %	Intervention (n = 114), %	P value
ICU: intensive care unit; IQR: interquartile range; tPA: tissue plasminogen activator; mRS: modified Rankin scale; NIHSS: National Institutes of Health Stroke Scale; DNR: do not resuscitate; DNI: do not intubate; CMO: comfort measures only; EVD: external ventricular drains; EEG: electroencephalogram; PEG: percutaneous endoscopic gastrostomy.
Age, median (IQR)	65 (55 - 76)	66 (58 - 75)	0.406
Gender			0.661
Female	34 (50.7%)	54 (47.4%)
Male	33(49.3%)	60 (52.6%)
Medical history
Hypertension	41 (61.2%)	87 (76.3%)	0.031
Hyperlipidemia	43 (64.2%)	82 (71.9%)	0.276
Diabetes mellitus	20 (29.9%)	37 (32.5%)	0.716
History of stroke	10 (14.9%)	17 (14.9%)	0.998
Atrial fibrillation	8 (11.9%)	28 (24.6%)	0.040
Coronary artery disease	16 (23.9%)	17 (14.9%)	0.131
Congestive heart failure	9 (13.4%)	14 (12.3%)	0.822
Peripheral arterial disease	2 (3%)	4 (3.5%)	1
Smoking history	36 (53.7%)	75 (65.8%)	0.108
Medications
Statin use	42 (62.7%)	87 (76.3%)	0.050
Anti-hypertensives use	43 (64.2%)	87 (76.3%)	0.080
Anti-diabetics use	17 (25.4%)	33 (28.9%)	0.604
Anti-platelets use	31 (46.3%)	64 (56.1%)	0.199
Oral anticoagulants use	9 (13.4%)	28 (24.6%)	0.073
Severity of illness on admission
Presenting NIHSS, median (IQR)	1 (0 - 3)	11 (3 - 22)	< 0.001
Presenting mRS, Median (IQR)	0 (0 - 1)	0 (0 - 1)	0.511
Diagnosis
Ischemic stroke	24 (35.8%)	67 (58.8%)	0.003
Hemorrhagic stroke	8 (11.9%)	14 (12.3%)	0.946
Non-stroke neurological	35 (52.2%)	33 (28.9%)	0.002

Goals of care discussed prior to transfer
Yes	2 (3%)	3 (2.6 %)	1
Code status upon transfer
Full code	55 (82.1%)	91 (79.8%)	0.710
DNR/DNI	8 (11.9%)	9 (7.9%)	0.368
CMO	4 (6%)	14 (12.3%)	0.171
Acuity of care upon transfer			< 0.001
ICU	27 (40.3%)	80 (70.2%)
Floor	40 (59.7%)	34 (29.8%)
Interventions upon transfer
Neurosurgery consult	28 (41.8%)	36 (31.6%)	0.165
IV thrombolysis	0 (0%)	30 (26.3%)	< 0.001
Thrombectomy	0 (0%)	45 (39.5%)	< 0.001
Craniectomy	0 (0%)	8 (7%)	0.027
EVD	0 (0%)	8 (7%)	0.027
EEG	0 (0%)	45 (39.5%)	< 0.001
PEG/tracheostomy	0 (0%)	4 (3.5%)	0.298
Palliative care consult	4 (6%)	8 (7%)	1

Table 1. Demographic and Characteristic Information of Patients With and Without Intervention

No intervention (n = 67), %

Intervention (n = 114), %

P value

ICU: intensive care unit; IQR: interquartile range; tPA: tissue plasminogen activator; mRS: modified Rankin scale; NIHSS: National Institutes of Health Stroke Scale; DNR: do not resuscitate; DNI: do not intubate; CMO: comfort measures only; EVD: external ventricular drains; EEG: electroencephalogram; PEG: percutaneous endoscopic gastrostomy.

Age, median (IQR)

65 (55 - 76)

66 (58 - 75)

0.406

Gender

0.661

Female

34 (50.7%)

54 (47.4%)

Male

33(49.3%)

60 (52.6%)

Medical history

Hypertension

41 (61.2%)

87 (76.3%)

0.031

Hyperlipidemia

43 (64.2%)

82 (71.9%)

0.276

Diabetes mellitus

20 (29.9%)

37 (32.5%)

0.716

History of stroke

10 (14.9%)

17 (14.9%)

0.998

Atrial fibrillation

8 (11.9%)

28 (24.6%)

0.040

Coronary artery disease

16 (23.9%)

17 (14.9%)

0.131

Congestive heart failure

9 (13.4%)

14 (12.3%)

0.822

Peripheral arterial disease

2 (3%)

4 (3.5%)

Smoking history

36 (53.7%)

75 (65.8%)

0.108

Medications

Statin use

42 (62.7%)

87 (76.3%)

0.050

Anti-hypertensives use

43 (64.2%)

87 (76.3%)

0.080

Anti-diabetics use

17 (25.4%)

33 (28.9%)

0.604

Anti-platelets use

31 (46.3%)

64 (56.1%)

0.199

Oral anticoagulants use

9 (13.4%)

28 (24.6%)

0.073

Severity of illness on admission

Presenting NIHSS, median (IQR)

1 (0 - 3)

11 (3 - 22)

< 0.001

Presenting mRS, Median (IQR)

0 (0 - 1)

0.511

Diagnosis

Ischemic stroke

24 (35.8%)

67 (58.8%)

0.003

Hemorrhagic stroke

8 (11.9%)

14 (12.3%)

0.946

Non-stroke neurological

35 (52.2%)

33 (28.9%)

0.002

Goals of care discussed prior to transfer

Yes

2 (3%)

3 (2.6 %)

Code status upon transfer

Full code

55 (82.1%)

91 (79.8%)

0.710

DNR/DNI

8 (11.9%)

9 (7.9%)

0.368

CMO

4 (6%)

14 (12.3%)

0.171

Acuity of care upon transfer

< 0.001

ICU

27 (40.3%)

80 (70.2%)

Floor

40 (59.7%)

34 (29.8%)

Interventions upon transfer

Neurosurgery consult

28 (41.8%)

36 (31.6%)

0.165

IV thrombolysis

0 (0%)

30 (26.3%)

< 0.001

Thrombectomy

0 (0%)

45 (39.5%)

< 0.001

Craniectomy

0 (0%)

8 (7%)

0.027

EVD

0 (0%)

8 (7%)

0.027

EEG

0 (0%)

45 (39.5%)

< 0.001

PEG/tracheostomy

0 (0%)

4 (3.5%)

0.298

Palliative care consult

4 (6%)

8 (7%)

**Table 2.** Immediate Outcomes of Mortality, LOS, Discharge Functional Status, and Neurological Status Following the Inter-Hospital Transfer
	Non-intervention (n = 67), %	Intervention (n = 114), %	P value
IQR: interquartile range; mRS: modified Rankin scale; NIHSS: National Institutes of Health Stroke Scale; LOS: length of stay.
Death during admission	7 (10.4%)	20 (17.5%)	0.196
LOS, (days) median (IQR)	3 (1 - 5)	6 (3 - 10)	< 0.001
Discharge mRS, median (IQR)	2 (1 - 4)	4 (2 - 4)	0.001
Discharge NIHSS, median (IQR)	0 (0 - 3)	4 (1 - 14)	< 0.001

Table 2. Immediate Outcomes of Mortality, LOS, Discharge Functional Status, and Neurological Status Following the Inter-Hospital Transfer

Non-intervention (n = 67), %

Intervention (n = 114), %

P value

IQR: interquartile range; mRS: modified Rankin scale; NIHSS: National Institutes of Health Stroke Scale; LOS: length of stay.

Death during admission

7 (10.4%)

20 (17.5%)

0.196

LOS, (days) median (IQR)

3 (1 - 5)

6 (3 - 10)

< 0.001

Discharge mRS, median (IQR)

2 (1 - 4)

4 (2 - 4)

0.001

Discharge NIHSS, median (IQR)

0 (0 - 3)

4 (1 - 14)

< 0.001

**Table 3.** Thirty-Day Readmission Rate and 90-Day Outcome Events Following the Inter-Hospital Transfer
	Non-intervention (n = 67), %	Intervention (n = 114), %	P value
Proportions were calculated by excluding 22 unknowns from analyses. IQR: interquartile range; mRS: modified Rankin scale; NIHSS: National Institutes of Health Stroke Scale; CV: cardiovascular.
30-day unpreventable readmission	9 (13.4%)	16 (14.0%)	0.910
90-day outcome events
No complication	39 (58.2)	71 (62.3)	0.588
Death	14 (20.9%)	26 (22.8%)	0.765
CV event	3 (4.5%)	4 (3.5%)	0.711
90-day mRS, median (IQR)	2 (0 - 6)	3 (1 - 6)	0.109
90-day NIHSS, median (IQR)	0 (0 - 3)	2 (0 - 11)	0.004

Table 3. Thirty-Day Readmission Rate and 90-Day Outcome Events Following the Inter-Hospital Transfer

Non-intervention (n = 67), %

Intervention (n = 114), %

P value

Proportions were calculated by excluding 22 unknowns from analyses. IQR: interquartile range; mRS: modified Rankin scale; NIHSS: National Institutes of Health Stroke Scale; CV: cardiovascular.

30-day unpreventable readmission

9 (13.4%)

16 (14.0%)

0.910

90-day outcome events

No complication

39 (58.2)

71 (62.3)

0.588

Death

14 (20.9%)

26 (22.8%)

0.765

CV event

3 (4.5%)

4 (3.5%)

0.711

90-day mRS, median (IQR)

2 (0 - 6)

3 (1 - 6)

0.109

90-day NIHSS, median (IQR)

0 (0 - 3)

2 (0 - 11)

0.004