Telestroke at Comprehensive Stroke Center During the COVID-19 Pandemic

NCT04761874 | Completed

• 1 other identifier: TC0002
• Study Type: interventional
• Target: 296
• Locations: 1 country
• Sites: 1

Brief Summary

TELEstroke to CAre for STroke Patients at a Comprehensive Stroke Center (TELECAST-CSC) during the COVID-19 pandemic is a pre-post study evaluating guideline-based acute ischemic stroke care following the implementation of inpatient telestroke at a comprehensive stroke center during the COVID-19 global pandemic. TELECAST-CSC compares two cohorts: the "in-person phase" (December 1, 2019-March 15, 2020), when all inpatient stroke team care was delivered conventionally in-person and the "telestroke phase" (March 16, 2020-June 29, 2020) when all inpatient stroke team care was delivered exclusively via telestroke as part of our healthcare system's pandemic response. We studied the following primarily clinical endpoints: diagnostic stroke evaluation, secondary stroke prevention, health screening and evaluation, stroke education, mortality, and stroke recurrence and readmission rates.

Conditions

Stroke, Acute

Keywords

Comprehensive stroke center; Ischemic stroke; Telestroke; Telemedicine; Secondary stroke prevention; COVID-19; SAR-Cov-2; pandemic

Outcome Measures

Primary Outcomes (1)

• Guideline-Based Inpatient Stroke Care

  A 24-item global assessment of fundamental inpatient acute ischemic stroke care informed by 2019 AHA guidelines comprising 4 categories: Diagnostic evaluation: Neurologist evaluation, head CT or brain MRI, intracranial vascular imaging, cervical vascular imaging, LDL, HgA1C, troponin, EKG, telemetry, echocardiogram, and outpatient prolonged cardiac monitoring. Secondary prevention: antiplatelet, dual antiplatelet, anticoagulation, statin, anti-hypertensives, diabetes management, symptomatic carotid revascularization. . Health screening and evaluation: swallow evaluation, cognitive assessment, rehabilitation evaluation Stroke evaluation: tobacco cessation counseling, exercise/ lifestyle counseling, signs of stroke. Each subject will be assessed for completion of these metrics. When a metric is not applicable for a specific patient, it will not be included in the analysis of guideline-based inpatient stroke care (e.g. tobacco cessation in a non-smoker).

  Inpatient hospitalization defined as the patient's admission through their discharge date (on average < 1 week)

Secondary Outcomes (2)

• Stroke Recurrence

  30 and 90 days post-hospital discharge

• Readmission Rate

  30 and 90 days post-hospital discharge

Other Outcomes (8)

• Transfer Rate

  Inpatient hospitalization defined as the patient's admission through their discharge date (on average < 1 week)

• Diagnostic Stroke Evaluation

  Inpatient hospitalization defined as the patient's admission through their discharge date (on average < 1 week)

• Secondary Stroke Prevention

  Inpatient hospitalization defined as the patient's admission through their discharge date (on average < 1 week)

Study Arms (2)

In-Person (Conventional) Stroke Care

NO INTERVENTION

Ischemic stroke patients admitted to a single academic, comprehensive stroke center from December 1, 2019-March 15, 2020 that were evaluated, managed, and treated by the stroke care team in person.

Telestroke Stroke Care

EXPERIMENTAL

Ischemic stroke patients admitted to a single academic, comprehensive stroke center from March 16, 2020-June 29, 2020 that were evaluated, managed, and treated by the stroke care team remotely via telestroke.

Other: Telestroke

Interventions

Telestroke OTHER

In the telestroke cohort, acute ischemic stroke patients at a single comprehensive stroke center received their stroke care and management exclusively via telestroke.

Telestroke Stroke Care

Eligibility Criteria

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

You may qualify if:

• Age 18 and above
• Patients with the primary diagnosis of ischemic stroke admitted to Fairview Southdale Hospitals
• 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 have an alternative diagnosis
• Patients who opt out of the study

Sponsors & Collaborators

• University of Minnesota: lead

Study Sites (1)

M Health Fairview Southdale Hospital

Edina, Minnesota, 55435, United States

Location

Related Publications (14)

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• Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-e418. doi: 10.1161/STR.0000000000000211. Epub 2019 Oct 30.

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MeSH Terms

Conditions

Stroke; Ischemic Stroke; COVID-19

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Pneumonia, Viral; Pneumonia; Respiratory Tract Infections; Infections; Virus Diseases; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Lung Diseases; Respiratory Tract Diseases

Study Officials

• Christopher Streib, MD

  The University of Minnesota

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This is a pre-post interventional study following inpatient telestroke intervention for longitudinal treatment of acute ischemic stroke patients at a comprehensive stroke center. The pre-treatment group is the conventional "in-person"cohort. The post-treatment group is the "telestroke" cohort. The groups were non-randomly allocated. All acute ischemic stroke patients admitted during phase 1 were include in the "in-person" cohort and all acute ischemic stroke patients admitted during phase 2 were included in the "telestroke cohort".

Study Record Dates

• First Submitted: February 15, 2021
• First Posted: February 21, 2021
• Study Start: December 1, 2019
• Primary Completion: June 29, 2020
• Study Completion: September 29, 2020
• Last Updated: April 22, 2021

Record last verified: 2021-04

Locations

US (1)