Interventional Telemedicine for Acute Stroke Management: Improving Time-to-Treatment in Remote Hospitals

Prof. David Klein; Dr. Akiko Sato; Dr. Omar Hassan

Abstract

Background: Acute stroke care is highly time-sensitive, yet access to specialized neurologists is often limited in remote or smaller hospitals, leading to delays in crucial interventions like thrombolysis. Interventional telemedicine (telestroke) can address this disparity. This study evaluated the impact of a telestroke network in improving time-to-treatment (Door-to-Needle time) and clinical outcomes for acute ischemic stroke patients presenting to spoke hospitals within the network. Methods: A retrospective cohort study analyzed data from 800 acute ischemic stroke patients at 12 spoke hospitals collaborating in a regional telestroke network over 2 years. Patients were compared to a historical control group before network implementation. Primary outcomes included median Door-to-Needle (DTN) time and proportion of patients receiving IV thrombolysis within 60 minutes. Secondary outcomes assessed 90-day modified Rankin Scale scores. Results: Implementation of telestroke significantly reduced median DTN time by 25 minutes (from 85 min to 60 min, p<0.001) and doubled the proportion of patients receiving thrombolysis within the golden hour (from 15% to 30%, p<0.001). Patients in the telestroke group also showed significantly better 90-day functional outcomes. Conclusion: Telestroke networks are critical for optimizing acute stroke care in underserved areas, drastically improving time-to-treatment and leading to better patient outcomes. These networks should be expanded to ensure equitable access to urgent neurological expertise.

Keywords: telemedicine, acute stroke, telestroke, time-to-treatment, neurology

Acute ischemic stroke is a leading cause of death and long-term disability, with outcomes critically dependent on rapid, expert neurological assessment and timely administration of thrombolytic therapy. However, the geographic distribution of stroke specialists leaves many smaller and rural hospitals without immediate access to this expertise, resulting in treatment delays that significantly worsen patient prognosis. Telestroke networks, utilizing real-time video consultations and remote imaging review, offer a powerful solution to bring specialized stroke care to the patient, regardless of location, thereby standardizing care, reducing time-to-treatment, and ultimately saving lives and improving functional recovery.

The aim of the study.

This study aimed to evaluate the impact of a newly implemented regional telestroke network on key quality metrics for acute ischemic stroke care, specifically focusing on Door-to-Needle (DTN) time and 90-day functional outcomes for patients presenting to remote spoke hospitals.

Material and methods.

A retrospective cohort study was conducted, analyzing data from 800 consecutive adult patients (age ≥18 years) diagnosed with acute ischemic stroke who presented to one of 12 spoke hospitals within a regional telestroke network over a 2-year period. This cohort was compared to a historical control group of 750 patients presenting to the same hospitals during the 2 years prior to telestroke network implementation. All patients received a non-contrast CT scan upon arrival. The telestroke intervention involved 24/7 access to a central hub of vascular neurologists via secure videoconferencing for acute stroke assessment and thrombolysis decision-making. Primary outcomes were median Door-to-Needle (DTN) time for intravenous thrombolysis and the proportion of patients receiving thrombolysis within 60 minutes of arrival. Secondary outcomes included the modified Rankin Scale (mRS) score at 90 days post-stroke and symptomatic intracerebral hemorrhage rates. Statistical analyses included Mann-Whitney U tests for DTN time, chi-square tests for proportions, and ordinal logistic regression for mRS scores, with significance set at p < 0.05.

Implementation of the telestroke network resulted in a significant reduction in the median DTN time, decreasing from 85 minutes (IQR 70-110) in the historical control group to 60 minutes (IQR 45-80) in the telestroke group (p < 0.001). The proportion of patients receiving intravenous thrombolysis within the recommended 60-minute DTN window more than doubled, increasing from 15% in the control group to 30% in the telestroke group (p < 0.001). Furthermore, patients in the telestroke group demonstrated significantly better 90-day functional outcomes, with a higher proportion achieving an mRS score of 0-2 (55% vs. 42% in control, adjusted odds ratio for better outcome 1.45, 95% CI 1.18-1.78, p = 0.002). No significant difference was observed in rates of symptomatic intracerebral hemorrhage (3.5% vs. 3.9%, p = 0.72).

Telestroke networks are profoundly effective in optimizing acute ischemic stroke care in non-specialized hospitals by significantly reducing time-to-treatment and improving 90-day functional outcomes. These findings underscore the critical role of interventional telemedicine in addressing geographical disparities in access to specialized stroke expertise. Widespread adoption and investment in robust telestroke infrastructure are essential for enhancing equitable, high-quality emergency neurological care and minimizing stroke-related disability across broad geographic regions.

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