LeSTER is a database that captures preliminary, clinical, treatment, and long term outcomes data on all stroke patients treated via the Telestroke Network of the Lone Star Stroke Consortium. The goal of the database is to understand the patterns, mechanisms, and impact of regional stroke care in the context of expanding the telestroke network in the state of Texas. We seek to understand how stroke care is delivered and how outcomes are achieved with the use of telemedicine.
Despite the substantiated clinical and cost benefits of intravenous (IV) tissue plasminogen activator (t-PA), for patients with ischemic stroke, it is estimated that only 2-5% of patients receive this treatment. Causes for the low treatment rate are numerous; however, one of the major reasons is the lack of access to acute neurological expertise.
Patients living in rural, under-served areas must rely on local community or critical access hospitals which may be uncomfortable in taking care of acute ischemic stroke patients or in initiating treatment with confidence. Unlike urban settings in which resources are more abundant and are more likely to attract vascular neurologists, rural and under-served areas often lack the means to entice neurologists into their community leading to a gap in access to acute stroke care. Nonetheless, some urban hospitals are also currently struggling with acute stroke coverage as shortages of neurologists continue to worsen and many community neurologists are unable to provide coverage to emergency rooms consistently.
A potential solution to increase access to acute neurological expertise is telemedicine. Telemedicine is the use of telecommunication technologies to provide medical information and services that allows for delivery of quality health care from afar. Telemedicine has been shown to be safe and effective in acute stroke care and can also improve utilization of IV t-PA. Currently in the state of Texas, it is estimated that 75% of the population has access to standalone primary stroke centers within 60 minutes and telemedicine increases the access to acute stroke care by ~8.5% or 2,026,016 additional Texans. Telemedicine can be used to expand access to acute stroke care for rural hospitals and provide additional back-up coverage to local neurologists that practice in the urban setting as well.
There continue to be substantial gaps in knowledge regarding the use of telemedicine in acute stroke care in the state of Texas. We do not know the full extent or impact of how telemedicine has changed acute stroke care and outcomes of stroke patients in Texas. We also need to understand how telemedicine services are useful for patients with other conditions such as brain hemorrhage. The Lone Star Stroke Consortium Telestroke Registry (LeSTER) is a database that will be aimed to address gaps in knowledge in this area.The registry will provide data regarding the types of patients that are being treated using telemedicine, utilization and quality metrics regarding IV t-PA administration as well as catheter-based reperfusion therapy, long term outcomes on stroke patients treated via Telemedicine, and possibly identify further needs of stroke patients in the state of Texas that telemedicine can provide.