학술논문
Abstract P282: Which Telestroke Transfers to the Hub Expire or Receive Hospice Within 48 Hours of Arrival?
Document Type
Article
Author
Source
Stroke (Ovid); March 2021, Vol. 52 Issue: Supplement 1 pAP282-AP282, 1p
Subject
Language
ISSN
00392499; 15244628
Abstract
Introduction:Telestroke (TS) expands access to acute stroke care and facilitates swift transfer of patients to tertiary stroke centers. However, patients transferred from spoke hospitals who expire shortly after arrival raises the question of whether there is opportunity to predict futility of transfer to a higher level of care. We examined acute ischemic stroke (AIS) patients transferred to our hub from TS spoke hospitals and identified who expired or went on to hospice within 48 hours of arrival.Methods:In our TS network, we identified AIS patients who were transferred from spoke hospitals following TS consultation (9/2015 - 12/2018). We compared demographic and clinical characteristics of patients who expired or went on to hospice within the first 48 hours versus those who did not. Hospice decision time was determined by chart review for documentation of goals of care discussions.Results:Of 530 transfers to the hub, there were 32 (6%) patients who expired or went on to hospice within 48 hours. Compared to those who did not, these patients had increased age (OR 1.08; 95% CI 1.05-1.12), higher incidence of atrial fibrillation (OR 2.24; 95% CI 1.02-4.90) or cancer (OR 3.04; 95% CI 1.17-7.87), higher pre-morbid mRS (OR 5.14; 95% CI 1.57-16.88), and higher NIHSS (OR 1.23; 95% CI 1.16-1.31). Interestingly, the same characteristics were also significantly different in those who expired or went on to hospice beyond 48 hours. There was no significant difference in demographic characteristics of sex and race/ethnicity. There was also no significant difference in the frequency of treatment with tPA or IAT; of the 32 patients who expired or went on to hospice within 48 hours, 21 (66%) had received tPA and 3 (9%) had undergone IAT. Palliative care was consulted for 31 (97%) of those patients.Conclusions:A relatively small but significant proportion of TS transfers to our hub expired or went on to hospice within 48 hours. These patients were characterized by increased age, poorer pre-stroke functional status and high stroke severity. In light of the current strain on resources with the pandemic, telepalliative services may help to better serve certain patients, in particular those who are elderly or debilitated, at spoke hospitals without the need for transfer to hub.