Survivors don't want 'care' YOU IMBECILIC BLITHERING IDIOTS! They want 100% recovery! All of you need to be fired for incompetence and leave the field!
Teleneurology Bests On-Site Rounds for Postacute Stroke Care
Teleneurology achieved near-perfect adherence to care(NOT RECOVERY!) guidelines(NOT PROTOCOLS!) in postacute stroke ward rounds, significantly outperforming conventional in-person consultations, a new study showed.Guidelines do not guarantee recovery;protocols, if done right, do!
In a prospective, multicenter, noninferiority study of more than 500 patients, use of teleneurology in ward rounds achieved 92% adherence to guidelines for such indicators as neurologic exam, diagnostic recommendations, and aftercare in postacute stroke. In-person, onsite rounds achieved just 54% adherence.
Teleneurology care(NOT RECOVERY!) also outperformed on-site care(NOT RECOVERY!) across all domains, with the largest differences seen in secondary prevention.
While the study met its goal of demonstrating noninferiority, achieving superiority was not unexpected, said lead investigator Janina R. Behrens, MD, Department of Neurology and the Center for Stroke Research Berlin at Charité – Universitätsmediz Berlin, Berlin, Germany.
“While both telemedicine and on-site neurologists in our study were provided with the same instructions and checklists, the routine use of specific tools in everyday telemedical practice may have supported a more consistent and systematic approach, potentially reducing the likelihood of overlooking relevant aspects of care(NOT RECOVERY!),” Behrens told Medscape Medical News.
The study was published online on April 6 in JAMA Neurology.
Telemedicine in Postacute Stroke?
Previous research has shown that the use of teleneurology in acute stroke care is associated with faster treatment and better outcomes. But the use of telemedicine in postacute care was unclear.
For the current study, VISIT STROKE, researchers evaluated whether teleneurologic ward rounds were noninferior to on-site consultations during subacute inpatient stroke care, with a focus on adherence to guideline-based quality measures for etiological classification, neurologic examination, risk assessment, diagnostic recommendations, secondary prevention, and recommended aftercare.
The researchers enrolled 518 patients (mean age, 71 years; 55.7% men) across 15 hospitals within four German telestroke networks, with 501 included in the final analysis.
Most patients had mild neurologic deficits and comorbidities were common, including arterial hypertension (83.3%), diabetes (29.4%), prior stroke (25.2%), and atrial fibrillation (23.5%).
Ischemic stroke was the most common diagnosis (61.5%), followed by transient ischemic attack (26.1%). Hemorrhagic stroke was rare, whereas 10% of cases were ultimately classified as stroke mimics.
Each patient received both a teleneurologic consultation and an on-site neurologic ward round within a median of 2.3 hours (IQR, 40 minutes-6 hours). Assessments were performed independently, and blinded neurovascular experts evaluated each consultation to assess guideline adherence.
Teleneurologists and on-site clinicians had the same standardized instruction and documentation tools, including standard operating procedures, checklists, and guideline-based frameworks for stroke care.
The primary outcome was adherence to the six predefined quality measures. Secondary outcomes included correctness of each individual measure and expert-rated assessments of completeness and accuracy.
Telestroke Bests On-Site Consultations
Teleneurologic ward rounds achieved complete adherence in 92% of cases (95% CI, 90%-94%) compared with 54% (95% CI, 49%-58%) for on-site consultations, exceeding the predefined noninferiority margin and demonstrating superiority.
A 38-percentage point difference was observed on average across all six quality measures. The largest gap was in secondary prevention, with a 21-percentage point difference between a 98% adherence rate with teleneurology and 77% adherence with on-site consultation.
Secondary prevention is an “area where recommendations are frequently updated and require constant integration of multiple patient-specific factors,” Behrens said.
Teleneurologic consultations were rated higher for both completeness and accuracy, with adjusted mean scores of 1.9 (95% CI, 1.6-2.2) and 1.8 (95% CI, 1.6-2.1), respectively.
Subgroup analyses supported the overall findings across patient sex, diagnosis, and timing of consultations, although one participating telestroke network achieved noninferiority but not superiority.
Study limitations included its observational design, inclusion of mostly patients with mild stroke, and lack of data on clinical outcomes, all of which limit generalizability, the researchers noted.
How Is Teleneurology Different?
The observed advantage between teleneurology and on-site may reflect differences in how care is organized, Behrens suggests.
“Teleneurological consultations are typically delivered by neurologists working within specialized stroke networks,” she said. “There is a strong focus on standardized protocols, continuous training, and adherence to current guidelines.”
In contrast, on-site consultations may occur in more variable clinical environments, with neurologists who differ in training, specialization, and familiarity with stroke-specific guidelines.
Most patients with stroke treated on wards in small rural hospitals had mild severity in the study. In the most severe cases, specifically those involving large-vessel occlusions, patients are typically transferred to thrombectomy centers, Behrens explained.
“Therefore, the concept evaluated in the study can be broadly applied to typical rural hospitals with a TeleStroke Unit,” she said.
Impact on Patient Outcomes Unknown
While interesting, the study’s findings reflect differences in training, experience level, and systems structure, said Shyam Prabhakaran, MD, chair of neurology at the University of Chicago Medicine in Chicago, who was not part of the study.
Standardized tools and decision support are key contributors to guidelines adherence, Prabhakaran told Medscape Medical News.
However, he cautioned that the results should be interpreted carefully. Although guideline adherence is an important indicator of quality, the study did not assess clinical outcomes such as functional recovery or mortality.
“We do not know that this model improves patient outcomes yet,” he said.
Incorporating teleneurology into routine postacute stroke care will require hospital buy-in and will not replace the “utility of in-person evaluation by neurologists and advanced practice providers in specific severe or unusual circumstances,” Prabhakaran said.
This study was funded by the German Innovation Fund of the Federal Joint Committee. Disclosure information for study authors is available in the original study publication. Prabhakaran reported having no relevant financial disclosures.
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