Telestroke for Comprehensive Stroke Care in Acute Stroke Ready Hospitals

NCT03672890 | Completed

• 1 other identifier: NEUR-2017-26226
• Study Type: observational
• Target: 551
• Locations: 1 country
• Sites: 5

Brief Summary

TELEstroke for Comprehensive Stroke Care in Acute Stroke Ready HospiTals (TELECAST) is a prospective single-center study evaluating guideline-based acute ischemic stroke care at an Acute Stroke Ready Hospital (ASRH) pre- and post-initiation of a specialist telestroke inpatient rounding service. TELECAST will study the following clinical endpoints: diagnostic stroke evaluation, secondary stroke prevention, health screening and evaluation, stroke education, inpatient complications, and stroke recurrence rates. Additional relevant non-clinical data will include patient and provider satisfaction scores, transfer patterns, and a cost analysis.

Conditions

Stroke

Keywords

Telestroke; Telemedicine; Stroke; Secondary stroke prevention

Outcome Measures

Primary Outcomes (1)

• Composite score of inpatient stroke care (%)

  A 23-item global assessment of fundamental inpatient acute ischemic stroke care primarily informed by AHA guidelines/GWTG criteria comprising 4 categories: * Diagnostic evaluation (10 items): neurologist evaluation, LDL, HgA1c, troponin, head CT or brain MRI, intracranial vascular imaging, cervical vascular imaging, EKG, telemetry, and outpatient prolonged cardiac monitoring. * Secondary prevention (6 items): antiplatelet, anticoagulation, statin, antihypertensives, diabetes management, and carotid revascularization. * Health screening \& evaluation (4 items): swallow evaluation, cognitive assessment, depression screening, and rehabilitation evaluation. * Stroke education (3 items): tobacco cessation counseling, exercise/lifestyle counseling, and signs of stroke. An item is not scored when not indicated clinically (for example tobacco cessation in a non-smoker), therefore the composite scores will be reported and analyzed as percentages.

  1 year after implementation of the inpatient telestroke service

Secondary Outcomes (5)

• Diagnostic Stroke Evaluation

  1 year after implementation of the inpatient telestroke service

• Secondary Stroke Prevention

  1 year after implementation of the inpatient telestroke service

• Health Screening & Evaluation

  1 year after implementation of the inpatient telestroke service

• Stroke Education

  1 year after implementation of the inpatient telestroke service

• Composite Stroke Recurrence

  Measured at 3 months and at 1 year after discharge

Other Outcomes (9)

• Acute Stroke Care

  1 year after implementation of the inpatient telestroke service

• Transfer patterns

  1 year after implementation of the inpatient telestroke service

• Inpatient complications

  1 year after implementation of the inpatient telestroke service

Study Arms (2)

Pre-Telestroke

Retrospective collection of defined metrics for all ischemic stroke patients admitted to the participating ASRH 2 years prior to implementation of an inpatient telestroke service.

Post-Telestroke

Prospective collection of defined metrics for all ischemic stroke patients admitted to the participating ASRH after implementation of an inpatient telestroke service.

Other: Telestroke

Interventions

Telestroke OTHER

Telestroke is an audiovisual communication network that allows for coordination of stroke care from a distant 'hub' site (the telestroke provider location) to an originating 'spoke' site (patient location) in a HIPAA compliant fashion. In TELECAST, inpatient telestroke rounding will be used to oversee the urgent diagnostic stroke evaluation, secondary stroke prevention, health screening \& evaluation, and stroke education in patients admitted with stroke.

Post-Telestroke

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

All patients admitted with a diagnosis of acute ischemic stroke at a participating ASRH two years before and one year after implementation of the telestroke inpatient service.

You may qualify if:

• Age 18 and above
• Patients with the primary diagnosis of ischemic stroke admitted to Fairview Ridges Hospital
• Evidence of stroke on MRI or CT or clinical diagnosis of acute ischemic stroke by the treating stroke service

You may not qualify if:

• Patients less than 18 years old
• Patients who leave the hospital against medical advice
• Patients with goals of care that impact the stroke evaluation (i.e. comfort measures)
• Patients who are felt to have an alternative diagnosis
• Patients who are transferred for higher-level stroke care such as endovascular thrombectomy or decompressive craniectomy

Sponsors & Collaborators

• University of Minnesota: lead

Study Sites (5)

Fairview Ridges Hospital

Burnsville, Minnesota, 55337, United States

Location

Grand Itasca Clinic and Hospital

Grand Rapids, Minnesota, 55744, United States

Location

Fairview Range Medical Center

Hibbing, Minnesota, 55746, United States

Location

Fairview Northland Medical Center

Princeton, Minnesota, 55371, United States

Location

Fairview Lakes Medical Center

Wyoming, Minnesota, 55092, United States

Location

Related Publications (15)

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MeSH Terms

Conditions

Stroke

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

Study Officials

• Christopher Streib, MD

  University of Minnesota

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Target Duration: 1 Year
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 13, 2018
• First Posted: September 17, 2018
• Study Start: October 2, 2018
• Primary Completion: July 30, 2019
• Study Completion: July 1, 2020
• Last Updated: February 16, 2021

Record last verified: 2021-02

Data Sharing

• IPD Sharing: Will not share

Locations

US (5)