1. Lone Star Stroke Consortium TeleStroke Registry (LESTER) Tzu-Ching (Teddy) Wu, MD Director of Telemedicine

2. Objective To understand the patterns, mechanisms, and impact of regional stroke care in the context of expanding Telestroke network in the state of Texas. We seek to understand how stroke care is delivered and how outcomes are achieved with the use of telemedicine. These objectives will be achieved by establishing a database (LeSTER) that would capture preliminary, clinical, treatment, and long term follow up outcomes data on all stroke patients treated via Telestroke Network of the Lone Star Stroke Consortium.

3. Methods Prospectively collect data on all telemedicine treated stroke patients from LSS. Retrospective data collection from (September 1, 2013) from chart review. Population: All presumed stroke patients on whom a telemedicine consultation is obtained would be included

4. Data Points Basic Information – Date of consult – Presumed / Initial Diagnosis – Hub / Spoke Hospital – Transfer Status – IV tPA administered (yes or no) – If not administered (reason) Demographic Information and Medical History – Age – Gender – Race – Past Medical History – Use of anticoagulation – Use of antiplatelet Clinical/Outcomes Information – Arrival and 24 Hour NIHSS – Discharge and Day 90 mRS/Disposition via phone interview – Discharge disposition – Length of Stay – Insurance status – Enrollment into clinical trial if applicable tPA treatment metrics if applicable – Stroke onset date and time – Arrival date and time – IV tPA treatment date and time – Off label use of IV tPA – IA therapy – IV tPA complications

5. Data Points Intra-arterial therapy time metrics if applicable – Hub Arrival time to repeat imaging if applicable – Time to angio-suite – Time to groin puncture – Time to clot – Time to recanalization – Initial and final TICI score – General anesthesia vs conscious sedation – Onset to groin puncture time – Onset to recanalization time Transfer Process Metrics if applicable – Date of transfer – Time of Transfer center contact by hub or spoke – Time departed from spoke – Travel time (depart to arrival to MHH-TMC) – Time of Arrival to hub

6. Project Status Protocol approved by UTHSC-Houston IRB o IRB approval letter provided to other LSS Hubs to initiate reciprocity process o With reciprocity, protocol amendments / revision will only need to be approved at UTHSC-Houston IRB

7. Project Status Retrospective Data Collection (9/1/13 to 9/30/15) o Currently with 2380 records o Total TPA patients = 530 o Total non-TPA patients = 1850 Prospective Data Collection o Started 11/1/15 o Workflow established

8. Possibilities Opportunities for Future Projects o Obtain data from non-LSS Texas telestroke providers o Use data to help study transfer process in the state regarding use of IAT