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December 2022; 12 (6) Research Article

Inpatient Teleneurology Follow-up Has Comparable Outcomes to In-Person Neurology Follow-up

Alicia M. Zha, Alyssa D. Trevino, Christy M. Ankrom, Kristie M. Chu, Michele M. Joseph, Tushar Patni, View ORCID ProfileTiffany D. Cossey, Sean I. Savitz, Tzu-Ching Wu, Amanda Jagolino-Cole
First published October 26, 2022, DOI: https://doi.org/10.1212/CPJ.0000000000200096
Alicia M. Zha
Department of Neurology (AMZ, ADT, SIS, AJ-C), University of Texas McGovern Medical School, Houston; Department of Neurology (AMZ), The Ohio State University Wexner Medical Center, Columbus; Current Neurology Solutions (CMA, KMC, MMJ, TDC, T-CW), Pearland TX; Department of Biostatistics (TP), St. Jude Children's Research Hospital, Memphis, TN; and Institute of Stroke and Cerebrovascular Disease (SIS, AJ-C), Department of Neurology, University of Texas McGovern Medical School, Houston.
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Alyssa D. Trevino
Department of Neurology (AMZ, ADT, SIS, AJ-C), University of Texas McGovern Medical School, Houston; Department of Neurology (AMZ), The Ohio State University Wexner Medical Center, Columbus; Current Neurology Solutions (CMA, KMC, MMJ, TDC, T-CW), Pearland TX; Department of Biostatistics (TP), St. Jude Children's Research Hospital, Memphis, TN; and Institute of Stroke and Cerebrovascular Disease (SIS, AJ-C), Department of Neurology, University of Texas McGovern Medical School, Houston.
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Christy M. Ankrom
Department of Neurology (AMZ, ADT, SIS, AJ-C), University of Texas McGovern Medical School, Houston; Department of Neurology (AMZ), The Ohio State University Wexner Medical Center, Columbus; Current Neurology Solutions (CMA, KMC, MMJ, TDC, T-CW), Pearland TX; Department of Biostatistics (TP), St. Jude Children's Research Hospital, Memphis, TN; and Institute of Stroke and Cerebrovascular Disease (SIS, AJ-C), Department of Neurology, University of Texas McGovern Medical School, Houston.
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Kristie M. Chu
Department of Neurology (AMZ, ADT, SIS, AJ-C), University of Texas McGovern Medical School, Houston; Department of Neurology (AMZ), The Ohio State University Wexner Medical Center, Columbus; Current Neurology Solutions (CMA, KMC, MMJ, TDC, T-CW), Pearland TX; Department of Biostatistics (TP), St. Jude Children's Research Hospital, Memphis, TN; and Institute of Stroke and Cerebrovascular Disease (SIS, AJ-C), Department of Neurology, University of Texas McGovern Medical School, Houston.
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Michele M. Joseph
Department of Neurology (AMZ, ADT, SIS, AJ-C), University of Texas McGovern Medical School, Houston; Department of Neurology (AMZ), The Ohio State University Wexner Medical Center, Columbus; Current Neurology Solutions (CMA, KMC, MMJ, TDC, T-CW), Pearland TX; Department of Biostatistics (TP), St. Jude Children's Research Hospital, Memphis, TN; and Institute of Stroke and Cerebrovascular Disease (SIS, AJ-C), Department of Neurology, University of Texas McGovern Medical School, Houston.
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Tushar Patni
Department of Neurology (AMZ, ADT, SIS, AJ-C), University of Texas McGovern Medical School, Houston; Department of Neurology (AMZ), The Ohio State University Wexner Medical Center, Columbus; Current Neurology Solutions (CMA, KMC, MMJ, TDC, T-CW), Pearland TX; Department of Biostatistics (TP), St. Jude Children's Research Hospital, Memphis, TN; and Institute of Stroke and Cerebrovascular Disease (SIS, AJ-C), Department of Neurology, University of Texas McGovern Medical School, Houston.
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Tiffany D. Cossey
Department of Neurology (AMZ, ADT, SIS, AJ-C), University of Texas McGovern Medical School, Houston; Department of Neurology (AMZ), The Ohio State University Wexner Medical Center, Columbus; Current Neurology Solutions (CMA, KMC, MMJ, TDC, T-CW), Pearland TX; Department of Biostatistics (TP), St. Jude Children's Research Hospital, Memphis, TN; and Institute of Stroke and Cerebrovascular Disease (SIS, AJ-C), Department of Neurology, University of Texas McGovern Medical School, Houston.
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  • ORCID record for Tiffany D. Cossey
Sean I. Savitz
Department of Neurology (AMZ, ADT, SIS, AJ-C), University of Texas McGovern Medical School, Houston; Department of Neurology (AMZ), The Ohio State University Wexner Medical Center, Columbus; Current Neurology Solutions (CMA, KMC, MMJ, TDC, T-CW), Pearland TX; Department of Biostatistics (TP), St. Jude Children's Research Hospital, Memphis, TN; and Institute of Stroke and Cerebrovascular Disease (SIS, AJ-C), Department of Neurology, University of Texas McGovern Medical School, Houston.
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Tzu-Ching Wu
Department of Neurology (AMZ, ADT, SIS, AJ-C), University of Texas McGovern Medical School, Houston; Department of Neurology (AMZ), The Ohio State University Wexner Medical Center, Columbus; Current Neurology Solutions (CMA, KMC, MMJ, TDC, T-CW), Pearland TX; Department of Biostatistics (TP), St. Jude Children's Research Hospital, Memphis, TN; and Institute of Stroke and Cerebrovascular Disease (SIS, AJ-C), Department of Neurology, University of Texas McGovern Medical School, Houston.
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Amanda Jagolino-Cole
Department of Neurology (AMZ, ADT, SIS, AJ-C), University of Texas McGovern Medical School, Houston; Department of Neurology (AMZ), The Ohio State University Wexner Medical Center, Columbus; Current Neurology Solutions (CMA, KMC, MMJ, TDC, T-CW), Pearland TX; Department of Biostatistics (TP), St. Jude Children's Research Hospital, Memphis, TN; and Institute of Stroke and Cerebrovascular Disease (SIS, AJ-C), Department of Neurology, University of Texas McGovern Medical School, Houston.
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Citation
Inpatient Teleneurology Follow-up Has Comparable Outcomes to In-Person Neurology Follow-up
Alicia M. Zha, Alyssa D. Trevino, Christy M. Ankrom, Kristie M. Chu, Michele M. Joseph, Tushar Patni, Tiffany D. Cossey, Sean I. Savitz, Tzu-Ching Wu, Amanda Jagolino-Cole
Neurol Clin Pract Dec 2022, 12 (6) e181-e188; DOI: 10.1212/CPJ.0000000000200096

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Abstract

Background and Objectives Community emergency departments often transfer patients for lack of neurology coverage, potentially burdening patients and accepting facilities. Telestroke improves access to acute stroke care, but there is a lack of data on inpatient teleneurology and telestroke care.

Methods From our prospective telestroke registry, we retrospectively reviewed 3702 consecutive patients who were seen via telestroke between September 2015 and December 2018. Patients who required transfer after initial telestroke evaluation or who were kept at hospitals without consistent neurology coverage were excluded from analysis. We compared baseline demographics, clinical characteristics, and hospital outcomes in patients who were subsequently followed remotely by a teleneurology neurohospitalist and those followed in person by a neurohospitalist.

Results There were 447 (23%) patients followed by a teleneurology neurohospitalist and 1459 (77%) patients followed in person by a neurohospitalist. Both groups presented with similar stroke severity. In multivariate analysis, there were no significant differences in discharge disposition, stroke readmission rates, or 90-day modified Rankin Scale (mRS) scores. Length of stay was shorter with teleneurology follow-up. In the subgroup of patients who received tissue plasminogen activator, patients showed no differences in outcomes and had similar complication rates. Teleneurology follow-up resulted in a 3% transfer rate for higher level of care after admission. There remained no difference in outcomes in a subanalysis without Comprehensive Stroke Centers. A higher proportion of non-Hispanic Black patients and a lower proportion of Hispanic patients in the teleneurology follow-up group were possibly due to spoke location demographics.

Discussion Teleneurology follow-up resulted in comparable outcomes to in-person neurology follow-up, with few transfers after admission. For select neurology and ischemic stroke patients, teleneurology follow-up provides an alternative to transfer for hospitals lacking neurology coverage.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • ↵* These authors contributed equally to this work and are co–first authors.

  • Submitted and externally peer reviewed. The handling editor was Associate Editor Belinda A. Savage-Edwards, MD, FAAN.

  • Received January 14, 2022.
  • Accepted September 15, 2022.
  • © 2022 American Academy of Neurology
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