Telemedicine networks for acute stroke: an analysis of global coverage, gaps and opportunities.
Journal: International journal of stroke : official journal of the International Stroke Society
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Affiliated Institutions:
Dept of Neurology, University Hospital Heidelberg, Germany.
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Florey Institute of Neuroscience and Mental Health, and Western Health, Victoria, Australia.
Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Ok, USA.
Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Dept of Neurology, Skane University Hospital, Clinical Sciences, Lund University, Sweden.
Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford. UK.
Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil.
Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia.
Department of Neurology, Faculty of Medicine, Transilvania University, Brasov, Romania.
Department of Medicine, Faculty of Medicine, National University of Malaysia (UKM), Kuala Lumpur, Malaysia.
Department of Medicine (Neurology), McMaster University and Population Health Research Institute, Hamilton, ON, Canada.
Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland.
Department of Neurology, Rashid Hospital, Mohammed bin Rashid University of Medical and Health Sciences, Dubai, UAE.
Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania.
Departament of Neurology, Comprehensive Stroke Center, Fleni. Ciudad de Buenos Aires, Argentina.
Hospital CEMESA/HNMCR, San Pedro Sula, Honduras.
Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM), Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom.
Department of Neurology, University Hospital Antwerp, Belgium.
Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.
Saudi German Hospitals, Jeddah, Saudi Arabia.
Dept of Neurology, University Hospital Erlangen, Erlangen, Germany.
Rajshahi Medical College, Rajshahi, Bangladesh.
Healthcare Innovation Technology Lab, San Camillo IRCCS, Venice, Italy.
Vickino Institute of Telehealth (VIT), Vickino, Yerevan, Armenia.
Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany.
Albert Einstein Hospital, Sao Paulo, Brazil and Departamento de Neurologia da Universidade Federal de São Paulo (UNIFESP).
Department of Medicine, University of Otago, Wellington, New Zealand.
Abstract summary
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.We aimed to map the global telestroke landscape and characterize existing networks.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.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 set-up was highly heterogenous, ranging from 17 (22%) networks with more than twenty 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 last three years were located in low- and middle-income countries (LMICs).This comprehensive global survey of telestroke networks found significant variation in network coverage, set-up, and technology use. Most services are in HICs, and 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.
Authors & Co-authors:
Tunkl Christine C
Agarwal Ayush A
Ramage Emily E
Velez Faddi Saleh FS
Roushdy Tamer T
Ullberg Teresa T
Li Linxin L
Carbonera Leonardo Augusto LA
Yusof Khan Abdul Hanif Khan AHK
Ciopleias Bogdan B
Law Zhe Kang ZK
Katsanos Aristeidis H AH
Heldner Mirjam R MR
Khan Maria M
Matuja Sarah Shali SS
Alet Matias J MJ
Lagos-Servellon Javier J
Minhas Jatinder S JS
Zuurbier Susanna S
Mosconi Maria Giulia MG
Lotlikar Radhika R
Elkady Ahmed A
Gerner Stefan T ST
Shreyan Shirsho S
Krauss Alexandra A
Gumbinger Christoph C
Srivastava Padma Mv PM
Kiper Pawel P
Ohannessian Robin R
Berberich Anne A
Sampaio Silva Gisele G
Ranta Anna A
Study Outcome
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