Deans' stroke musings: Teleneurology vs On-Site Neurology Consultation for Postadmission Hospital Care of Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, April 7, 2026

Teleneurology vs On-Site Neurology Consultation for Postadmission Hospital Care of Stroke

Every single stroke round IS COMPLETELY FUCKING USELESS! Your doctor HAS NOTHING FOR 100% RECOVERY! The only goal in stroke! That is how fucking incompetent everyone in stroke is! The key word signifying incompetence is 'CARE'; NOT RECOVERY! You don't have to go any farther than the word 'care' to declare incompetence. So how simple it is to evaluate stroke.

Send me personal hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name(If you can't stand by your name don't bother replying anonymously) and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely state EXACTLY WHERE I'M WRONG. I want to hear your excuses for failure(not getting to 100% recovery IS FAILURE!) so I can demolish them! You aren't solving to 100% recovery protocols with NO EXCUSES! I've never received any communications from any stroke association. You'd think they would want to talk to their fiercest critic, but no, they are hiding under a rock someplace, probably don't even know I exist! Swearing at me is allowed, I'll return the favor. Don't even attempt to use the excuse that brain research is hard.

Teleneurology vs On-Site Neurology Consultation for Postadmission Hospital Care of Stroke

JAMA Neurol

Published Online: April 6, 2026

doi: 10.1001/jamaneurol.2026.0615

Question Are telestroke ward rounds during subacute inpatient stroke care(NOT RECOVERY!) noninferior to conventional on-site ward rounds? Findings In this noninferiority study that included 501 patients, telestroke ward rounds were rated as guideline adherent in 92% vs 52% for the on-site ward rounds, suggesting not only noninferiority but also superiority.

Meaning These findings support the integration of telemedicine into routine inpatient stroke care(NOT RECOVERY!), particularly in regions with limited access to neurological expertise.

Abstract

Importance Telestroke networks provide coverage of neurological expertise in rural areas. While most teleneurological consultations focus on acute stroke care(NOT RECOVERY!) in emergency departments, neurological expertise remains crucial in the subacute phase. However, teleneurological ward rounds have not yet been systematically investigated for feasibility and quality.

Objective To assess noninferiority of teleneurological ward rounds compared with conventional on-site ward rounds during subacute inpatient stroke care(NOT RECOVERY!), focusing on adherence to guideline-based quality indicators.

Design, Setting, and Participants This prospective, multicenter, nonrandomized, noninferiority study was conducted at 15 primary care hospitals within 4 German telestroke networks from October 2022 to December 2024. Adults (18 years or older) hospitalized with suspected acute ischemic or hemorrhagic stroke or transient ischemic attack were eligible. A total of 1908 patients were screened. These data were analyzed from January 2025 to May 2025.

Exposures Patients received both a teleneurological and an on-site neurological ward round. Teleneurological ward rounds were performed by network neurologists via video consultation; on-site consultations were performed by local neurologists. Documentation from both consultations was evaluated by blinded external neurovascular experts.

Main Outcomes and Measures The primary outcome was complete fulfillment of 6 predefined, guideline-based quality domains: etiological classification, neurological examination, risk assessment, diagnostic recommendations, secondary prevention, and recommended aftercare. Noninferiority was defined as a maximum difference in proportions of correct assessments of 5 percentage points. Secondary outcomes included correctness of individual domains and expert quality ratings on a visual analoge scale.

Results A total of 518 patients were enrolled (median age, 71 years; 222 female [44%] and 296 male [56%]) and 501 were included in the final analysis. Complete adherence to all quality criteria was achieved in 92% (95% CI, 90%-94%) of teleneurological ward rounds compared with 54% (95% CI, 49%-58%) of on-site ward rounds (absolute difference, 38 percentage points; 90% CI, 34-42). Superiority of teleneurological ward rounds was consistent across all quality domains with the most pronounced differences observed for secondary prevention (absolute difference, 21% percentage points; 90% CI, 17-24).

Conclusions and relevance Teleneurological ward rounds in subacute stroke care(NOT RECOVERY!) were noninferior and even superior when compared with on-site consultations, with respect to guideline adherence across all quality domains. These findings support the integration of telemedicine into routine inpatient stroke care(NOT RECOVERY!), particularly in regions with limited access to neurological expertise.