Remote evaluation of pre-stroke driving, shopping, banking capability as an alternative to modified rankin for reperfusion decisions - results from a telestroke dataset.

Abstract

Background: Reliable assessment of premorbid function is essential to guide decisions for stroke reperfusion therapies. In the Victorian Stroke Telemedicine (VST) Service, reported ability to perform driving, shopping and banking (DSB) has been used to quickly and reliably ascertain premorbid function, in conjunction with the modified Rankin Scale (mRS). Aim(s): To investigate if the rapid assessment of DSB ability can be a substitute for mRS in reperfusion decisions. Method(s): Data were collected as part of the VST Service (July 2023 to April 2024). Patient demographics and clinical information were collected including clinical diagnosis, stroke severity, symptom onset and reperfusion treatment advised (thrombolysis [tPA], endovascular thrombectomy [EVT]). Multivariable regression models were used to assess associations between variables. Result(s): There were 1,616 consultations provided to patients with ischaemic stroke (57% male; mean age 72.8 years, 71% mRS of 0-1, 66% performing all DSB). Of these, 264 patients were recommended for tPA and 213 patients were recommended for ECR. mRS of 0-1 was associated with driving (odds ratio [OR] 22.4, 95% CI 14.3 - 35.0), shopping (OR 2.35, 95% CI 1.14 - 4.86) and banking (OR 6.04, 95% CI 3.02 - 12.1). Recommendation for reperfusion therapy (tPA / EVT) was associated with ability to perform one component of DSB (OR 4.23, 95% CI 2.80 - 6.38), and the ability to perform all DSB activities (OR 3.01 95% CI 2.16 - 4.21). Conclusion(s): Ascertaining the ability to perform DSB is simple and fast and has the potential to inform provision of reperfusion therapies.