Effect of Telestroke on Emergent Stroke Care and Stroke Outcomes
The delivery of medical care through telecommunication has been available in one form or another for ≈100 years. In the early 1900s, people living in remote areas of Australia used 2-way radios (powered by dynamos and bicycle pedals) to communicate with the Australian Royal Flying Doctor Service. The first direct reference to telemedicine in the literature was in the 1950s, with the transmission of radiological images by telephone in Philadelphia, closely followed by the teleradiology system established in Montreal, Canada.1 Telemedicine by video communication was first implemented by the University of Nebraska in the 1960s to allow clinicians to service remote populations.1 Jumping forward to the 21st century, there are now ≥55 telestroke programs in 27 states of the United States that deliver stroke services to ≥350 spoke hospitals.2
To justify the use of telestroke, there is a need for evidence of benefit. However, evaluating the outcomes of a telestroke program is complex because clinical outcomes from treating patients with acute stroke and wider health system and financial metrics need to be captured. The purpose of this review is to provide an overview of the various outcomes of stroke telemedicine and to outline the new paradigms evolving for systems of care, research, and education, as well as financial considerations.
Stroke telemedicine (or telestroke) is the practice of clinical stroke care via telecommunication and came into its own with the era of stroke thrombolysis in the late 1990s. A key driver was to ensure better equity for patients in accessing this time-critical therapy in metropolitan and rural hospitals. Our knowledge base on the benefits of stroke thrombolysis continues to develop. The totality of evidence through pooled data analysis indicates that the therapeutic benefit of recombinant tissue-type plasminogen activator (tPA) is time dependent and is greatest when given early …