Synopsis

LESTER is a telestroke registry that is the first of its kind to seek to understand how stroke care is delivered and how outcomes are achieved with the use of telemedicine in the state. A web-based registry is implemented at sites where a telestroke service is active and primarily involves a stroke coordinator or primary contact who sends a short monthly report on discharge information of admitted stroke patients seen over telemedicine. This will help understand the patterns, mechanisms, and impact of regional stroke care in the context of expanding the telestroke network in the state of Texas.

LeSTER captures preliminary, clinical, treatment, and long-term follow up outcomes data on all stroke patients treated via Telestroke Network of the Lone Star Stroke Consortium. Participation from 3 Lone Star Stroke hubs (UTHealth Houston, UTHSC San Antonio, Seton Healthcare) and their spokes (25); 9,889 consults in the registry from 9/2015-06/2018.

Impact

A stroke is when a blood vessel in the brain is blocked by a blood clot which leads to brain dysfunction. When detected early, it can be treated with a “clot-busting” medication and in certain patients with large blood clots, they may be eligible for a catheter-based treatment aimed to extract the clot surgically. Both treatments need to be delivered fast in order for the stroke patient to maximize the chance for a good outcome. Unfortunately, there is a lack of access to acute stroke expertise in the state of Texas and many hospitals in our state and many facilities have turned to telemedicine for assistance. By utilizing live two-way audio and video technology, telemedicine allows remote facilities to have 24/7, nearly instant access to an acute stroke physician that can quickly diagnose and help deliver proper treatment to the patient.

Publications

A manuscript on the LeSTER methods has been submitted for publication.

LESTER data led to the acceptance of five posters at the International Stroke Conference, Los Angeles, California in January 2018.

• Using Telemedicine Eliminates the Weekend After-Hours Effect in Acute Ischemic Stroke Patients
• Inter- Rater Reliability of Telephonic Modified Rankin Scale Obtained for a Telestroke Network
• Similar Outcomes for Patients Treated with Off-label vs On-label Tissue Plasminogen Activator via Telestroke
• Outcomes of Telestroke tPA Patients Who Stay at Community Hospitals vs Transfer to a Comprehensive Stroke Center