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. See 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 and title(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

1. Janina R. Behrens, MD^1,2; 
   Maximilian Kaffes, MD^1,2; 
   Annette Aigner, PhD^2,3
 
2. et al

 

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.

Telemedicine Use in Stroke Linked to Delayed Treatment

 This should make no difference whatsoever! COMPETENT? HOSPITALS WILL HAVE 100% RECOVERY PROTOCOLS REGARDLESS OF TIME PRESENTED!

So, your hospital is completely fucking incompetent then?

Telemedicine Use in Stroke Linked to Delayed Treatment

TOPLINE:

Evaluation via telemedicine in stroke care, or “telestroke,” enhances access to thrombolysis for acute ischemic stroke but leads to significant treatment delays, with patients 44% less likely to receive guideline-concordant door-to-needle (DTN) times within 60 minutes, a multicenter registry study showed. While improving treatment accessibility, telestroke evaluation was associated with 6.55 minutes longer DTN times and 47 minutes longer door-in-door-out (DIDO) transfer times than standard care.

METHODOLOGY:

• Researchers analyzed 3036 patients with acute ischemic stroke (mean age, 70 years; 51.5% men; 77.5% White individuals) in 42 hospitals from the Paul Coverdell Michigan Stroke Registry between 2022 and 2023.
• Participants potentially eligible for thrombolysis were evaluated either using telestroke (26%) or without it (74%).
• Primary outcomes were administration of thrombolysis and DTN treatment time as both continuous and categorical variables (≤ 60 vs > 60 minutes).
• Secondary outcomes included the occurrence of postthrombolytic symptomatic intracerebral hemorrhage (ICH), in-hospital mortality, discharge modified Rankin Scale (mRS) score, discharge ambulatory status, discharge destination, DTN treatment time, and DIDO time of transferred patients. The outcomes were adjusted for demographics, medical history, and patient and hospital characteristics.

TAKEAWAY:

• Thrombolysis was administered to 55.5% of patients evaluated via telestroke vs 55.0% evaluated without it, with evaluation via telestroke associated with higher odds of receiving thrombolysis (adjusted odds ratio [aOR], 1.61; P = .003) but lower odds of receiving it within 60 minutes (aOR, 0.56; P = .002).
• Patients evaluated by telestroke had delayed treatment with longer DTN (mean difference 6.55 minutes; P = .003) and median DTN (53 vs 46 minutes; P < .001) treatment times as well as a longer median DIDO time (166 vs 150 minutes; P < .001) than those not evaluated by telestroke.
• Fewer patients evaluated by telestroke received guideline-concordant DTN treatment within 60 minutes than those not evaluated by telestroke (60.3% vs 72.3%; P < .001).
• Outcomes including postthrombolytic symptomatic ICH, in-hospital mortality, discharge mRS score, ambulatory status, and discharge destination did not differ significantly between groups after adjustment.

IN PRACTICE:

“Telestroke care has the potential to revolutionize acute stroke treatment by improving access to lifesaving treatment, but our findings highlight clear gaps in the ability to promptly treat these patients after they are evaluated. This is a major opportunity for quality improvement to identify unique factors in telestroke systems that contribute to treatment delays,” the lead author said in a press release.

The authors of an accompanying editorial wrote, “Improvement efforts should address processes at both hub and spoke hospitals. With continued assessment of processes and outcomes across stroke systems of care, and collaboration beyond traditional health system boundaries, we can further improve outcomes for patients treated with telestroke.”

SOURCE:

The study was led by Brian Stamm, MD, clinical assistant professor of neurology at University of Michigan Medical School, Ann Arbor, Michigan. The accompanying editorial was authored by Laura K. Stein, MD, MPH, Icahn School of Medicine, Mount Sinai, New York City, and Kori S. Zachrison, MD, MSc, Mass General Brigham and Harvard Medical School, Boston. The commentary and the study were published online on September 26 in JAMA Network Open.

Telestroke and Timely Treatment and Outcomes in Patients With Acute Ischemic Stroke

 So, complete fucking failure at business101; not even measuring 100% recovery! Does anyone in stroke KNOW HOW TO THINK?

But you don't tell us 100% recovery results; the only goal in stroke! Why, because you're not measuring it or because they are still so fucking awful?

Here is your business101 requirements.

“What's measured, improves.” So said management legend and author Peter F. Drucker  

The latest crapola here:

Telestroke and Timely Treatment and Outcomes in Patients With Acute Ischemic Stroke

1. Brian Stamm, MD, MSc^1,2,3,4; Rachael T. Whitney, PhD⁵; Regina Royan, MD, MPH^1,2,6,7
2. et al

Key Points

Question  How do treatment times and stroke outcomes in patients with acute ischemic stroke evaluated by telestroke compare with those not evaluated by telestroke?

Findings  In this cohort study of 3036 patients with acute ischemic stroke potentially eligible for thrombolysis, telestroke was associated with a higher odds of receiving thrombolysis, but significantly prolonged door-to-needle and door-in-door-out times and a lower odds of meeting guideline-concordant door-to-needle times within 60 minutes, compared with nontelestroke.

Meaning  These findings suggest that there is room to improve timely stroke treatment for patients evaluated by telestroke to ensure that all patients with ischemic stroke receive guideline-concordant, time-sensitive care(NOT RECOVERY!).

(Guidelines don't guarantee recovery; protocols do!)

Abstract

Importance  Telestroke has the potential to revolutionize acute stroke treatment by improving access to optimal stroke care, including time-sensitive care such as thrombolysis. However, it is unclear how treatment times and stroke outcomes compare between patients evaluated and not evaluated by telestroke.

Objective  To evaluate the association between telestroke use and acute stroke treatment times and outcomes.

Design, Setting, and Participants  This retrospective cohort study included patients with acute ischemic stroke aged 18 years or older presenting to 42 Paul Coverdell Michigan Stroke Registry hospitals from January 1, 2022, to December 31, 2023. All patients were potentially eligible for thrombolysis (ie, presented ≤4 hours of last known well, no contraindications to thrombolysis documented).

Exposure  Telestroke (vs nontelestroke) encounter.

Main Outcomes and Measures  The primary outcomes were receipt of thrombolysis and door-to-needle (DTN) time as a continuous variable and a categorical variable (≤60 vs >60 minutes).

(TOTALLY WRONG OUTCOMES TO MEASURE! Survivors want recovery you blithering idiots, measure that!) Secondary outcomes included discharge ambulatory status, discharge destination, and door-in-door-out (DIDO) time in transferred patients. Multivariable hierarchical models evaluated associations between telestroke (vs nontelestroke) activation and outcomes, sequentially adjusting for demographics, medical history, presentation or arrival, and hospital characteristics.

Results  Among the 3036 patients with acute ischemic stroke potentially eligible for thrombolysis (mean [SD] age, 69.7 [14.5] years; 1563 male [51.5%]), 785 (25.9%) were evaluated using telestroke and 2251 (74.1%) without telestroke. A total of 1673 patients (55.1%) were treated with thrombolysis. In the fully adjusted models, patients evaluated by telestroke had a significantly higher odds of receiving thrombolysis (adjusted odds ratio, 1.61; 95% CI, 1.17-2.23) but longer DTN times (6.55 minutes longer; 95% CI, 2.12-10.97 minutes longer) and lower odds of meeting a guideline-concordant DTN time within 60 minutes (adjusted odds ratio, 0.56; 95% CI, 0.39-0.81) compared with those not evaluated by telestroke. Among 255 patients who underwent interhospital transfer, 207 (81.2%) received thrombolysis, and patients with telestroke had significantly longer DIDO times (46.90 minutes longer, 95% CI, 1.08-92.72 minutes longer).

Conclusions and Relevance  In this cohort study of patients with acute ischemic stroke potentially eligible for thrombolysis, those evaluated by telestroke had a 61% higher odds of receiving thrombolysis but a 44% lower odds of meeting guideline-concordant DTN times within 60 minutes and prolonged DIDO times compared with those not evaluated by telestroke. Future research should investigate modifiable factors that contribute to treatment delays in patients with ischemic stroke evaluated via telestroke.

Introduction

Acute ischemic stroke (AIS) treatment is not only highly efficacious but also highly time-sensitive.^1,2 Faster time to treatment with intravenous thrombolysis (door to needle [DTN]) is associated with improved outcomes in AIS.¹ For patients with a large vessel occlusion, approximately 1.9 million neurons die during each minute without treatment.³ Target: Stroke is a national quality improvement campaign by the American Heart Association (AHA) that achieved significant overall reductions in DTN times.^4-6 Since its inception in 2010, Target: Stroke has set increasingly bold benchmarks for DTN times, with the most recent goal of achieving a DTN within 60 minutes in 85% of patients treated with intravenous thrombolysis.⁷

While thrombolysis is highly efficacious for acute stroke, not all hospitals have stroke specialists. Telestroke has revolutionized the treatment of acute stroke by improving access to expert stroke care.⁸ Telestroke connects stroke specialists (typically from a comprehensive stroke center or hub site) to spoke sites (typically primary stroke centers) to aid in acute stroke decision-making and treatment.⁹ Telestroke has led to an increased uptake of acute stroke therapies, including thrombolysis,⁸ and has grown across the nation, becoming a vital component of stroke systems of care.^8,10 However, several studies from single systems found that telestroke treatment times at spoke hospitals, including DTN times, were significantly prolonged,^11-15 with worse inpatient and discharge stroke outcomes¹² compared with standard, in-person stroke care.

A larger-scale comparison of telestroke vs standard stroke care has been difficult to perform given challenges with identifying patient-level telestroke encounters in standard administrative data. The Paul Coverdell Michigan Stroke Registry started routinely tracking telestroke encounters in 2022. This study used this state-level stroke registry to compare thrombolysis treatment rates, DTN times, and other evidence-based stroke hospitalization and discharge outcomes in patients evaluated via telestroke vs not.

Regional Queensland to receive new life-saving Telestroke service

It is YOUR RESPONSIBILITY  to infiltrate the Stroke Foundation and DEMAND 100% RECOVERY. This tyranny of low expectations of just good recovery needs to stop. Whomever is in charge now will want 100% recovery when they are the 1 in 4 per WHO that has a stroke!

When you have a stroke you'll want recovery and you'll kick yourself for not doing that job when you could.

Regional Queensland to receive new life-saving Telestroke service

Stroke Foundation

Regional and remote Queenslanders will soon have access to a life-saving service that will increase their chances of survival and a good recovery after having a stroke.

The Queensland Government today announced it will roll out a $5.8M Telestroke service which will provide survivors of stroke immediate access to Queensland’s best stroke specialist doctors for assessment and advice on initial treatments.

Stroke Foundation Chief Executive Officer, Dr Lisa Murphy, says this is a welcome and critical addition to Queensland’s current stroke services.

” We applaud the Queensland Government’s decision to implement Telestroke and know it will go a long way in giving people right across Queensland equal access to specialist stroke assessment and treatment.

Queensland Health’s Telestroke service, which will launch in 2024, will allow stroke specialists to review brain scans and assess patients remotely via video to diagnose and decide on a treatment plan as quickly as possible.

“Access to Telestroke both increases the rate of thrombolysis or clot busting medication, administered in regional hospitals and increases the speed at which this time-critical treatment is given. This translates to less death and disability following stroke,” Dr Murphy said.

The service will support approximately two million Queenslanders who live in regional and rural areas who have minimal or no stroke specialist coverage locally to manage acute stroke presentations.

“Regional Australians are 17 per cent more likely to experience a stroke than people living in metropolitan areas so it is critical that Australians, regardless of their postcode, have access to equitable and immediate stroke treatment and that’s exactly what Telestroke will deliver.”

The Stroke Foundation is proud to have been working with the Queensland Government for two decades providing support to hospital stroke teams to improve stroke care.(NOT RESULTS OR RECOVERY!)

VA hospital telestroke networks improve treatment, lower ED transfer rate

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us and AND are improving treatment but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results.  ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

 

VA hospital telestroke networks improve treatment, lower ED transfer rate

By Robert Herpen, MA

Source/Disclosures

ADD TOPIC TO EMAIL ALERTS

Telestroke networks improve acute stroke treatment for veterans and positively affect the efficiency of interhospital networks by avoiding unnecessary ED transfers, according to a study published in Neurology.

“Interhospital transfer for stroke has increased over the past two decades, particularly with the expansion of eligibility for endovascular thrombectomy,” Michael J. Lyerly, MD, associate professor of neurology at the University of Alabama at Birmingham, and colleagues wrote. “This has the potential to overburden tertiary centers with stroke mimics or thrombectomy-ineligible patients, as well as to increase health care expenditures.”

Source: Adobe Stock.

Researchers sought to examine the impact and effectiveness of the VA National Telestroke Program on hospital transfers among U.S. military veterans diagnosed with acute ischemic stroke (AIS).

The study analyzed 3,488 stroke encounters from 3,289 patients across 21 VA hospitals before (n = 1,056) and after (n = 2,432) implementation of the program. Researchers assessed transfer rates through administrative data and chart review and documented patient and facility-level characteristics to identify potential transfer predictors.

According to study results, there was an absolute 14.4% decrease in transfers across all levels of stroke center designation following program implementation. Reasons for transfer included younger age, higher stroke severity and shorter duration from symptom onset. Researchers also found that only hospitals with lower annual stroke volume were more likely to transfer AIS patients, with just one hospital experiencing an increase in transfer rate after program implementation.

Further, implementation of the program resulted in a nearly 60% reduction in transfer odds, after adjusting for patient and facility characteristics (OR, 0.39; 0.19-0.77).

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“Our analysis suggests that, within a national health care system, in addition to improving stroke treatment rates, a potential decrease in unnecessary ED transfers may be another way that telestroke improves the quality and efficiency of stroke systems of     ,” Lyerly and colleagues wrote.

 

Safety and Efficacy of the Telestroke Drip-and-Stay Model: A systematic review and meta-analysis

So being non-inferior it fails just as bad as these other methods.Good to know failure is being normalized. Only 12% get full recovery from tPA, which is complete failure in any sense of the word. Unless your tyranny of low expectations is so low that reperfusion alone is considered a success.

 Safety and Efficacy of the Telestroke Drip-and-Stay Model: A systematic review and meta-analysis

Hena Waseem¹, Yasir Salih², Charles Burney¹, Mark Abel¹, Natalie Riblet², Nathaniel Robbins^3
1Dartmouth Hitchcock Medical Center, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, ²The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, ³Dartmouth Hitchcock Medical Center

Objective:

To compare outcomes between two models of acute ischemic stroke care in patients treated with IV tissue plasminogen activator (tPA) at a spoke hospital in a telestroke network, with subsequent treatment at the spoke hospital (“drip-and-stay”), compared with treatment with tPA at a spoke hospital with subsequent transfer to a hub hospital (“drip-and-ship”), or both tPA and subsequent treatment at a hub hospital (“hub”).

Background:

In the “drip-and-stay” model of telestroke care patients presenting at a spoke facility complete their entire hospital stay at the spoke. Despite potential benefits, including resource utilization, the drip-and-stay model has not yet been widely adopted, and relatively little is known about outcomes compared to hub or drip-and-ship models.

Design/Methods:

We performed a systematic review and meta-analysis according to PRISMA guidelines. Literature searches of MEDLINE, Embase, and Cochrane from inception-October 2019 included randomized control trials (RCTs) and observational cohort studies comparing the drip-and-stay model to hub and drip-and-ship models. Outcomes of interest were functional independence (modified Rankin scale), symptomatic intracranial hemorrhage (sICH), mortality, and length of stay (LOS). Pooled effect estimates were calculated using a fixed-effects meta-analysis and random-effects Bayesian meta-analysis. Non-inferiority was calculated using a fixed-margin method. 

Results:

Of 2,806 unique records identified, 10 studies, totaling 4,164 patients, fulfilled the eligibility criteria. Meta-analysis found no significant difference in functional outcomes (mRS 0-1) (6 studies, RR=1.09, 95%CI 0.98-1.22, p=0.123), sICH (8 studies, RR=0.98, 95%CI 0.64-1.51, p=0.942), or 90-day mortality (5 studies, RR=0.98, 95%CI 0.73-1.32, p=0.911, respectively) between patients treated in a drip-and-stay model compared to patients treated in drip-and-ship or hub models. No outcomes showed significant heterogeneity. Drip-and-stay outcomes (mRS 0-1, sICH) were non-inferior when compared to the combined group.

Conclusions:

Our findings indicate that drip-and-stay is non-inferior to current models of hub and drip-and-ship stroke care, and may be as safe and as effective as either.

 

No Stroke Expertise? Specialist on Speed Dial Boosts Outcomes

 Oh God, 'better care'! The tyranny of low expectations in full display. Aren't you glad your doctors and researchers are OK with this lazy crapola? Massive amounts of chest thumping for what should be regular care. When you get to 100% recovery then you can celebrate, until then just shut up and do your job, which is 100% recovery in case you missed that goal.

No Stroke Expertise? Specialist on Speed Dial Boosts Outcomes

Stroke care compared between hospitals with and without telestroke technology

by Nicole Lou, Staff Writer, MedPage Today March 1, 2021

Stroke patients received better care(NOT RECOVERY!) at hospitals lacking on-site stroke expertise if they had telestroke capacity, according to large observational study.

Reperfusion treatment, through thrombolysis or thrombectomy, was more likely among acute ischemic stroke patients at telestroke centers compared with matched peers treated without either on-site or virtual capacity (6.8% vs 6.0%, RR 1.13, 95% CI 1.09-1.17), reported Ateev Mehrotra, MD, MPH, of Harvard Medical School, and colleagues in a paper published online in JAMA Neurology.

Telestroke made the biggest difference for rural patients and the lowest-volume hospitals (admitting fewer than two strokes per month), whereas higher-volume centers (averaging at least two strokes per week) showed no improvement in reperfusion therapy by telestroke capacity.

Approximately 30% of all hospitals emergency departments in the U.S. now use telestroke technology. Although low-volume and rural hospitals showed the greatest benefits of telestroke, they were least likely to have telestroke capacity in the study.

Better reimbursement or direct financial support may encourage these hospitals to adopt telestroke, Mehrotra's team suggested, noting that barriers to adoption may include insufficient financial investment, lack of high-speed internet in rural communities, and regulations that limit financial support from tertiary hospitals.

Mehrotra's group also showed higher reperfusion rates at telestroke centers among patients 85 years and older, for whom emergency medicine physicians may be uncomfortable using thrombolysis given the associated increased risk of intracerebral hemorrhage in the oldest age group.

Telestroke extends stroke expertise to hospitals without on-site stroke expertise, where emergency departments are staffed by people with less exposure to stroke care(NOT RECOVERY!) and thus lower comfort levels with reperfusion decisions. Remote consultations permit contact between a stroke specialist, the bedside care(NOT RECOVERY!) provider, and the patient.

Study investigators compiled Medicare data on acute stroke admissions in the U.S. in which the patient had first presented to a hospital without on-site stroke expertise in 2008-2017. They found 76,636 matched pairs of patients (57.7% women, mean age 78.8 years) going to hospitals with or without telestroke.

There was no evidence that stroke care(NOT RECOVERY!) had previously been superior at hospitals that eventually adopted telestroke.

Mortality rates at 30 days favored stroke patients at telestroke-capable hospitals (13.1% vs 13.6%, RR 0.96, 95% CI 0.94-0.99). However, the effect dissipated by 6 months (22.6% vs 23.0%, RR 0.98, 95% CI RR 0.97-1.00).

The two groups had similar healthcare costs (institutional spending $26,560 vs $26,524) and functional status (60.25 vs 60.22 days alive in the community after discharge) through 90 days.

"To our knowledge, this is the first study to demonstrate that telestroke is associated with a clinically meaningful reduction in mortality and improved use of reperfusion treatments with no increase in health care spending," Mehrotra and colleagues noted.

"Though cost-effective from the perspective of Medicare, it is important to emphasize that local hospitals must pay for telestroke capacity, and these payments are not captured in our data," they cautioned.

Other limitations of the study include unobserved confounding, the lack of data on symptom onset and other patient factors in Medicare records, and the reliance on community living as a proxy measure of functional outcome after stroke.

"Given the increasing prevalence of telestroke in EDs and current state of evidence, it is unlikely that a randomized clinical trial of telestroke vs placebo is feasible given the ethics of not offering patients effective stroke care(NOT RECOVERY!). Therefore, we believe this form of rigorous observational study is likely to be the best evidence available on the association of telestroke with treatment and outcomes for patients with acute ischemic stroke," study investigators wrote.

• 

  Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

The study was supported by a grant from the National Institute of Neurological Disorders and Stroke.

Mehrotra had no disclosures.

Study coauthors reported ties to Genentech, Life Image, the Massachusetts Department of Public Health, Penumbra, Diffusion Pharma, the Agency for Healthcare Research and Quality, Controlled Risk Insurance Company, and the American College of Emergency Physicians.

Primary Source

JAMA Neurology

Source Reference: Wilcock AD, et al "Reperfusion treatment and stroke outcomes in hospitals with telestroke capacity" JAMA Neurol 2021; DOI: 10.1001/jamaneurol.2021.0023.

 

Reperfusion Treatment and Stroke Outcomes in Hospitals With Telestroke Capacity

'More likely' IS NOT WHAT THE FUCK THIS RESEARCH IS SUPPOSED TO BE ABOUT!  Since you didn't measure 100% recovery this was useless.

Reperfusion Treatment and Stroke Outcomes in Hospitals With Telestroke Capacity

Andrew D. Wilcock, PhD¹; Lee H. Schwamm, MD^2,3; Jose R. Zubizarreta, PhD^4,5,6; et al Kori S. Zachrison, MD, MSc^2,7; Lori Uscher-Pines, PhD⁸; Jessica V. Richard, BS⁴; Ateev Mehrotra, MD, MPH^4,9

Author Affiliations

JAMA Neurol. Published online March 1, 2021. doi:10.1001/jamaneurol.2021.0023

Key Points

Question  What is the association between telestroke capacity and care patterns and outcomes(You didn't measure 100% recovery?) for patients with acute ischemic stroke?

Findings  In this study including 153 272 patients treated for stroke, those who received care at hospitals with telestroke capacity had higher rates of reperfusion treatment and lower 30-day mortality compared with those treated at hospitals without telestroke. Increases in reperfusion treatment were largest in smaller hospitals, among rural residents, and among patients 85 years and older.

Meaning  Patients who present to hospitals with telestroke capacity were more likely to receive reperfusion treatment and have lower mortality.

Abstract

Importance  Telestroke is increasingly used in hospital emergency departments, but there has been limited research on its impact on treatment and outcomes.

Objective  To describe differences in care patterns and outcomes among patients with acute ischemic stroke who present to hospitals with and without telestroke capacity.

Design, Setting, and Participants  Patients with acute ischemic stroke who first presented to hospitals with telestroke capacity were matched with patients who presented to control hospitals without telestroke capacity. All traditional Medicare beneficiaries with a primary diagnosis of acute ischemic stroke (approximately 2.5 million) who presented to a hospital between January 2008 and June 2017 were considered. Matching was based on sociodemographic and clinical characteristics, hospital characteristics, and month and year of admission. Hospitals included short-term acute care and critical access hospitals in the US without local stroke expertise. In 643 hospitals with telestroke capacity, there were 76 636 patients with stroke who were matched 1:1 to patients at similar hospitals without telestroke capacity. Data were analyzed in July 2020.

Main Outcomes and Measures  Receipt of reperfusion treatment through thrombolysis with alteplase or thrombectomy, mortality at 30 days from admission, spending through 90 days from admission, and functional status as measured by days spent living in the community after discharge.

Results  In the final sample of 153 272 patients, 88 386 (57.7%) were female, and the mean (SD) age was 78.8 (10.4) years. Patients cared for at telestroke hospitals had higher rates of reperfusion treatment compared with those cared for at control hospitals (6.8% vs 6.0%; difference, 0.78 percentage points; 95% CI, 0.54-1.03; P < .001) and lower 30-day mortality (13.1% vs 13.6%; difference, 0.50 percentage points; 95% CI, 0.17-0.83, P = .003). There were no differences in days spent living in the community following discharge or in spending. Increases in reperfusion treatment were largest in the lowest-volume hospitals, among rural residents, and among patients 85 years and older.

Conclusions and Relevance  Patients with ischemic stroke treated at hospitals with telestroke capacity were more likely to receive reperfusion treatment and have lower 30-day mortality.

Full Text

 

Advances in Stroke Digital Health

 I would count on nothing here actually helping survivors get to 100% recovery. 'Care' is referred to twice but nothing on results or recovery, so useless.

Advances in Stroke Digital Health

Gisele Sampaio Silva

,

Lee H. Schwamm

Originally published22 Dec 2020https://doi.org/10.1161/STROKEAHA.120.033239Stroke. 2021;52:351–355

Abstract

The year 2020 has undoubtedly made Digital Health a necessity and no longer an exception. Many technological advances that seemed futuristic became a reality in a few months due to the pandemic’s needs. Stroke was one of the diseases that most benefited from the digital health revolution. Due to the need for immediate care and a shortage of neurologists worldwide, telestroke has revolutionized the acute care of cerebrovascular diseases in many areas based on strong scientific evidence. In this brief article, we have tried to summarize all we have experienced in 2020, the year which irreversibly transformed the practice of medicine.

 

Reaching for the cloud: telestroke; Australian Stroke Alliance

Your definition of success is vastly different that stroke survivors.(AND WRONG)

 100% RECOVERY is the only goal in stroke! You are going to have to scream in these supposedly smart peoples faces.

Reaching for the cloud: telestroke; Australian Stroke Alliance

The Australian Stroke Alliance plans to build upon the telestroke model that has been successful in Victoria, creating Australia’s first national digital telestroke network.

The earlier we treat a stroke, the better the outcome. In Victoria, patients in rural and remote communities have been able to access early stroke care through the Victorian Stroke Telemedicine program, coordinated through Ambulance Victoria. It has successfully supported regional stroke treatment, on a small scale, with 17 regional hospitals in Victoria and two in Tasmania. They are linked with emergency services and stroke specialists in metropolitan Melbourne. This has improved the quality of stroke care and enabled thrombolysis to be given earlier and more safely.

“It is always frustrating seeing patients who have lost their ability to walk or speak after a stroke. But this is worse when you know that they could not receive treatment just because they lived remotely. Stroke treatment should not depend on the place where you live.”

– Dr Alvaro Cervera, neurologist, Royal Darwin Hospital

The wider application of the telestroke model is limited by old technologies and piecemeal implementation. Currently, each state implements patchwork telestroke models which do not include all regions and where each network uses a different set of protocols to make treatment decisions based on different minimum clinical data. Patient follow-up is rarely performed, leaving a critical gap in the monitoring of patient outcome. This is particularly important because the most significant risk factor for having a stroke is having previously had a stroke (10 per cent in the first three months after stroke and 6 per cent every year after).

The Alliance’s telehealth platform

• Addresses the growing disparity in stroke outcomes for rural, remote and Indigenous communities
• Offers real time assessment for stroke intervention in remote locations, supporting rural practitioners in diagnosis and treatment
• Implements a nationally coordinated stroke telemedicine network to overcome various limited services.

As well, it will:

• Build on the highly successful Victorian Stroke Telemedicine Service which has delivered safe thrombolysis for seven years. (Who the fuck cares about safety? Survivors want recovery. Talk to them sometime.)
  
• Work with all states and territories to offer a national, digital system. Currently Tasmania, NSW, WA and QLD are developing versions of the Victorian program, emphasising the need for a national approach
• Adapt to different geographies responding to the need for tailored approaches to telehealth. We know that one size does not fit all.
• Design telestroke models to meet the specific needs of regional Indigenous Australians who have a 3-fold rate of acute ischemic stroke and mortality compared to non-Indigenous Australians.

A truly national network

The Alliance will create three important links: to local ambulance services in all states and territories, to patients’ electronic patient records and to a data hub for optimisation modelling. This will be a world-first for mobile pre-hospital stroke care, enabling not just more effective and efficient care but it will underpin long-term optimisation of emergency health resource deployment across our vast country.

“Telemedicine services are now operating in limited areas, but more investment is required to develop a nationally coordinated stroke telemedicine network.”

– No Postcode Untouched report: Stroke Foundation (2017)

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There’s an app for that

Scaling up telestroke capability to reach all of Australia demands a new and digital approach. A cloud-based system with links to regional hubs and customised app-based tools will be used in the field. This will finally enable frontline GPs, paramedics and nurses at the scene of a remote stroke to receive an unprecedented level of support through seamless videoconferencing with a roster of stroke physicians 24-hours a day.

A new level of care will be delivered using a suite of tools enabling clinical dialogue – including AI-driven automation. Simplified and easy to interpret images will be produced for rapid assessment. Stroke physicians will be given enough information to advise on the appropriate treatment at the scene.

We know it will work because we have piloted a cloud-based model of telestroke on the Australia’s first stroke ambulance, Melbourne’s mobile stroke ambulance. We have developed a mobile app that transmits crucial clinical data and brain images, as well as audio-visuals of the patient from the vehicle to stroke specialists.

We are ready to adapt the app so it works in a range of space-constrained environments like a helicopter or rural road ambulance, supporting doctors, paramedics and nurses as never before.

These developments will lay the foundations for a digital ecosystem, ready for our novel mobile stroke units to plug in when launched across the country. This will link remote air and road stroke ambulances to city-based medical specialists and electronic patient records – and a data hub for optimisation modelling.

This is a real-time solution for remote Australians who have, until now, been overlooked.

 

Air vs. Road Decision for Endovascular Clot Retrieval in a Rural Telestroke Network

You wouldn't need to make decisions like this if you have protocols leading to 100% recovery for all survivors. This is thinking small and not the sign of true leadership. 

Air vs. Road Decision for Endovascular Clot Retrieval in a Rural Telestroke Network

Shyam Gangadharan^1*, Thomas Lillicrap², Ferdinand Miteff^1,2, Pablo Garcia-Bermejo¹, Thomas Wellings¹, Billy O'Brien³, James Evans³, Khaled Alanati¹, Christopher Levi^1,2, Mark W. Parsons^2,4, Andrew Bivard^2,4, Carlos Garcia-Esperon^1,2† and Neil J. Spratt^1,2† for the Northern NSW Telestroke Investigators

• ¹Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
• ²Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
• ³Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
• ⁴Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia

Background and Purpose: Telestroke aims to increase access to endovascular clot retrieval (ECR) for rural areas. There is limited information on transfer workflow for ECR in rural settings. We sought to describe the transfer metrics for ECR in a rural telestroke network with respect to decision making.

Methods: A retrospective cohort study was employed on consecutive patients transferred to the comprehensive stroke center (CSC) for ECR in a rural hub-and-spoke telestroke network between April 2013 and October 2019, by road or air. Key time-based metrics were analyzed.

Results: Sixty-two patients were included. Mean age was 66 years [standard deviation (SD), 14] and median National Institutes of Health Stroke Scale 13 [interquartile range (IQR), 8–18]. Median rural-hospital-door-to-CSC-door (D2D) was 308 min (IQR, 254–351), of which 68% was spent at rural hospitals [door-in-door-out (DIDO); 214 min; IQR, 171–247]. DIDO was longer for air transfers than road (P = 0.004), primarily because of a median 87 min greater decision-to-departure time (Decision-DO, P < 0.001). In multiple linear regression analysis, intubation but not thrombolysis was associated with significantly longer DIDO. The distance at which the extra speed of an aircraft made up for the delays involved in booking an aircraft was 299 km from the CSC.

Conclusions: DIDO is longer for air retrievals compared with road. Decision-DO represents the most important component of DIDO, being longer for air transfers. Systems for rapid transportation of rural ECR candidates need optimization for best patient outcomes, with decision support seen as a potential tool to achieve this.

Introduction

Endovascular clot retrieval (ECR) is the standard of care in the treatment of acute stroke patients with large vessel occlusion (LVO) (1). It has been shown to be major benefits in selected patients up to 24 h (2, 3), but earlier treatment leads to greater benefit (4–6). This presents logistical challenges in Australia, because patients from widely dispersed geographic regions are eligible for this treatment, but it is offered only in limited metropolitan centers (7, 8).

Telestroke is being increasingly used in Australia to help overcome geographical disparities in access to acute stroke care (9–11). Optimal implementation of ECR through telestroke requires efficient workflow from primary hospital to the comprehensive stroke center. Door-in-door-out (DIDO) time at the primary hospital has been thought to have the greatest impact on outcome for patients with LVO being transferred for ECR, among modifiable factors (12–14). A recent study in metropolitan Australia proposed that the target time for DIDO should be shortened to 45 min (15, 16).

Despite the fact that about 29% of Australia's population live in rural and remote areas, with people in very remote areas having a mortality rate almost 1.4 times as high as in major cities (17), there is a paucity of data on transfer workflow specific to rural Australia to guide further development of ECR in these areas. We aimed to describe the transfer metrics for ECR from rural hospitals to a regional comprehensive stroke center in a telestroke network in rural Australia, with respect to key points in clinical decision making.

Clinical decision making in stroke care is complex (18), with there being a correlation between decision delay in acute stroke and both pre-hospital and in-hospital delays (19–21). In addition to transfer workflow, we extended our study to look at the relationship between transfer metrics and clinical decision making so that the results might be more readily adapted to modify routine clinical practice and potentially identify areas for decision support. We sought to compare different transport modalities. Our main hypothesis was that DIDO for air transfers would be longer than for road transfers.