Telemedicine networks for acute stroke: An analysis of global coverage, gaps, and opportunities

Tunkl C 1 , Agarwal A 2 , Ramage E 3 , Velez FS 4 , Roushdy T 5 , Ullberg T 6 Show all authors , Li L 7 , Carbonera LA 8 , Yusof Khan AHK 9 , Ciopleias B 10 , Law ZK 11 , Katsanos AH 12 , Heldner MR 13 , Khan M 14 , Matuja S 15 , Alet MJ 16 , Lagos-Servellón J 17 , Minhas JS 18 , Zuurbier SM 19 , Mosconi MG 20 , Lotlikar R 21 , Elkady A 22 , Gerner ST 23 , Shreyan S 24 , Krauss A 1 , Gumbinger C 1 , Srivastava P 2 , Kiper P 25 , Ohannessian R 26 , Berberich A 27 , Sampaio Silva G 28 , Ranta A 29

Affiliations 

  • 1 Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
  • 2 Department of Neurology, All India Institute of Medical Sciences, New Delhi, New Delhi, India
  • 3 The Florey Institute of Neuroscience and Mental Health, and Western Health, Parkville, VIC, Australia
  • 4 Department of Neurology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
  • 5 Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  • 6 Department of Neurology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
  • 7 Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  • 8 Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil
  • 9 Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
  • 10 Department of Neurology, Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania
  • 11 Department of Medicine, Faculty of Medicine, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
  • 12 Department of Medicine (Neurology), McMaster University and Population Health Research Institute, Hamilton, ON, Canada
  • 13 Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
  • 14 Department of Neurology, Rashid Hospital, Mohammed Bin Rashid University of Medical and Health Sciences, Dubai, UAE
  • 15 Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
  • 16 Department of Neurology, Comprehensive Stroke Center, Fleni, Ciudad de Buenos Aires, Argentina
  • 17 Hospital CEMESA/HNMCR, San Pedro Sula, Honduras
  • 18 Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM), Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
  • 19 Department of Neurology, University Hospital Antwerp, Edegem, Belgium
  • 20 Internal Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
  • 21 Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
  • 22 Saudi German Hospitals, Jeddah, Saudi Arabia
  • 23 Department of Neurology, University Hospital Erlangen, Erlangen, Germany
  • 24 Rajshahi Medical College, Rajshahi, Bangladesh
  • 25 Healthcare Innovation Technology Lab, San Camillo IRCCS, Venice, Italy
  • 26 Vickino Institute of Telehealth (VIT), Vickino, Yerevan, Armenia
  • 27 Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
  • 28 Albert Einstein Hospital, Sao Paulo, Brazil
  • 29 Department of Medicine, University of Otago, Wellington, New Zealand
Int J Stroke, 2024 Nov 15.
PMID: 39460528 DOI: 10.1177/17474930241298450

Abstract

BACKGROUND: Despite the proven efficacy of telestroke in improving clinical outcomes by providing access to specialized expertise and allowing rapid expert hyperacute stroke management and decision-making, detailed operational evidence is scarce, especially for less developed or lower income regions.

AIM: We aimed to map the global telestroke landscape and characterize existing networks.

METHODS: We employed a four-tiered approach to comprehensively identify telestroke networks, primarily involving engagement with national stroke experts, stroke societies, and international stroke authorities. A carefully designed questionnaire was then distributed to the leaders of all identified networks to assess these networks' structures, processes, and outcomes.

RESULTS: We identified 254 telestroke networks distributed across 67 countries. High-income countries (HICs) concentrated 175 (69%) of the networks. No evidence of telestroke services was found in 58 (30%) countries. From the identified networks, 88 (34%) completed the survey, being 61 (71%) located in HICs. Network setup was highly heterogeneous, ranging from 17 (22%) networks with more than 20 affiliated hospitals, providing thousands of annual consultations using purpose-built highly specialized technology, to 11 (13%) networks with fewer than 120 consultations annually using generic videoconferencing equipment. Real-time video and image transfer was employed in 64 (75%) networks, while 62 (74%) conducting quality monitoring. Most networks established in the past 3 years were located in low- and middle-income countries (LMICs).

CONCLUSION: This comprehensive global survey of telestroke networks found significant variation in network coverage, setup, and technology use. Most services are in HICs, and a few services are in LMICs, although an emerging trend of new networks in these regions marks a pivotal moment in global telestroke care. The wide variation in quality monitoring practices across networks, with many failing to report key performance metrics, underscores the urgent need for standardized, resource-appropriate, quality assurance measures that can be adapted to diverse settings.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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