Comparative Clinical Outcomes of Intravenous r-tPA Administration for Acute Stroke Patients: Hospital-Based vs. Telestroke in Community Hospitals in Sakon Nakhon Province
Keywords:
rtPA, Telestroke, Community hospitalAbstract
Background: Limited access to acute ischemic stroke treatment leads to delays in administering intravenous thrombolysis (rtPA). This study aims to compare clinical outcomes between patients treated at Sakon Nakhon Hospital (Hub) and those treated via the Telestroke network at community hospitals.
Methods: A prospective cohort study was conducted from 2018 to 2024, involving 457 acute ischemic stroke patients receiving rtPA (262 at the Hub hospital and 195 at community hospitals). The primary outcome was a good functional recovery (modified Rankin Scale [mRS] 0–1) at 90 days. Generalized Linear Models were utilized to identify predictors of good outcomes.
Results: The community hospital group demonstrated a significantly higher rate of good recovery compared to the Hub group (74.36% vs. 57.2%; OR = 0.462, p < 0.001) and a higher rate of improvement within 24 hours (84.1% vs. 72.14%). The mean length of hospital stay was significantly shorter in the Telestroke group (5.09 vs. 7.32 days; p < 0.001). No significant differences were observed in mortality rates (3.1% vs. 4.6%) or symptomatic intracerebral hemorrhage (4.6% vs. 7.3%). Significant predictors for good recovery included age $<60$ years, higher ASPECTS scores, onset-to-door time $<60$ minutes, mechanical thrombectomy, and lower baseline NIHSS scores.
Conclusion: Administering rtPA via Telestroke in community hospitals yields comparable or superior efficacy and safety profiles compared to the stroke center. These findings support the expansion of Telestroke technology to enhance treatment accessibility in rural areas.
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