Quality and safety of Telemedicine in acute ischemic stroke: Early experience in Taiwan

Effect of teleconsultation on the application of thrombolytic therapy in stroke patients in the emergency department

INTRODUCTION

Recently, telemedicine has become a widely used method worldwide for the treatment of patients with acute ischemic stroke in hospitals where neurologists are unavailable. The purpose of this study was to determine the accuracy and reliability of treatment decisions made by remote neurologists via teleconference assisted by emergency physicians in acute stroke cases and to determine whether the use of teleconsultation would lead to any delays in assessment and treatment decisions.

METHODS

This single-center and prospective study was performed with 104 patients who met the inclusion criteria. Patients were concurrently assessed by a teleneurologist (TN) experienced in stroke and an on-site neurologist (OS-N). The TN performed their assessment via teleconference and assisted by an emergency physician for test results and physical examination. NIHSS (The National Institutes of Health Stroke Scale) scores, assessment times, treatment decisions by the two neurologists, and patient outcomes were recorded separately. The TN was asked to rate the quality of communication.

RESULTS

Of the 104 patients in the study, 59.6% (n = 62) were men and the median age was 66 (interquartile range = 56-78) years. The median duration of assessment by the OS-N was 30 (18-45) min and the median duration of assessment by the TN was 6 (5-8) min; the duration of assessment by the TN was significantly shorter (6.56 min vs. 33.35 min; Z = 8.669; p < 0.001). The median rating assigned by the TN to the quality of teleconsultation was 5.0 (4.25-5.0) (Table 1). The NIHSS scores assigned by both neurologists showed significant correlation (p < 0.001). Analysis of the agreement between the OS-N and TN in their treatment decisions yielded a Kappa value of 74.3% for interrater agreement.

CONCLUSIONS

Teleconsultation was a successful and reliable strategy in assessing patients with ischemic stroke and making decisions for IV-tPA. Moreover, patient assessment via teleconsultation was less time consuming. The results of the study are promising for the use of teleconsultation in the future.

Global stroke statistics 2023: Availability of reperfusion services around the world

BACKGROUND

Disparities in the availability of reperfusion services for acute ischemic stroke are considerable globally and require urgent attention. Contemporary data on the availability of reperfusion services in different countries are used to provide the necessary evidence to prioritize where access to acute stroke treatment is needed.

AIMS

To provide a snapshot of published literature on the provision of reperfusion services globally, including when facilitated by telemedicine or mobile stroke unit services.

METHODS

We searched PubMed to identify original articles, published up to January 2023 for the most recent, representative, and relevant patient-level data for each country. Keywords included thrombolysis, endovascular thrombectomy and telemedicine. We also screened reference lists of review articles, citation history of articles, and the gray literature. The information is provided as a narrative summary.

RESULTS

Of 11,222 potentially eligible articles retrieved, 148 were included for review following de-duplications and full-text review. Data were also obtained from national stroke clinical registry reports, Registry of Stroke Care Quality (RES-Q) and PRE-hospital Stroke Treatment Organization (PRESTO) repositories, and other national sources. Overall, we found evidence of the provision of intravenous thrombolysis services in 70 countries (63% high-income countries (HICs)) and endovascular thrombectomy services in 33 countries (68% HICs), corresponding to far less than half of the countries in the world. Recent data (from 2019 or later) were lacking for 35 of 67 countries with known year of data (52%). We found published data on 74 different stroke telemedicine programs (93% in HICs) and 14 active mobile stroke unit pre-hospital ambulance services (80% in HICs) around the world.

CONCLUSION

Despite remarkable advancements in reperfusion therapies for stroke, it is evident from available patient-level data that their availability remains unevenly distributed globally. Contemporary published data on availability of reperfusion services remain scarce, even in HICs, thereby making it difficult to reliably ascertain current gaps in the provision of this vital acute stroke treatment around the world.