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Telestroke

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Teleneurology in Practice

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Abstract

Cerebrovascular disease, including acute ischemic stroke, remains a major public health problem in the USA and throughout the world. There has been a concerted effort to apply evidence-based practices to stroke care in order to improve primary and secondary prevention as well as poststroke outcomes. However, geography and workforce shortages contribute to disparities in access to acute stroke care, especially among the substantial proportion of the US population that lives outside the reach of a primary stroke center. In an attempt to combat this rural- or suburban-to-urban disparity and expand the availability of best stroke practices, Levine and Gorman proposed the development of telemedical outreach for acute stroke evaluation and management, which they called “telestroke.” Since then, scientific evidence supporting telestroke has accumulated, with excellent interrater agreement between telemedicine-enabled versus bedside assessment of the National Institutes of Health Stroke Scale (NIHSS) score, increased correct recombinant tissue plasminogen activator (rt-PA) decision making by telestroke as compared to telephone-only consultation, and the telestroke model has been calculated to be cost-effective from both a societal and a hospital perspective. In light of these findings and the perception of benefit by acute stroke providers and patients, there has been a rapid expansion of telestroke networks in the USA and internationally. Further research is needed to understand the potential merits of telestroke infrastructure for the many phases of stroke care including prehospital emergency medical systems, poststroke hospitalization, prevention of complications, enhancing secondary prevention, and education of patients and providers.

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Author information

Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, Jacksonville, FL, USA

    Mark N. Rubin MD

  2. Mayo Clinic College of Medicine, Phoenix, AZ, USA

    Bart M. Demaerschalk

  3. Stroke Service, MassGeneral TeleHealth, Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston, MA, USA

    Lee H. Schwamm MD

  4. University of Pittsburgh Medical School and University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Lawrence R. Wechsler MD

Authors
  1. Mark N. Rubin MD
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  2. Bart M. Demaerschalk
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  3. Lee H. Schwamm MD
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  4. Lawrence R. Wechsler MD
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Corresponding author

Correspondence to Mark N. Rubin MD .

Editor information

Editors and Affiliations

  1. Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

    Jack W. Tsao

  2. Neurology, Professor of Neurology, Mayo Clinic Mayo Clinic College of Medicine, Phoenix, Arizona, USA

    Bart M. Demaerschalk

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Rubin, M., Demaerschalk, B., Schwamm, L., Wechsler, L. (2015). Telestroke. In: Tsao, J., Demaerschalk, B. (eds) Teleneurology in Practice. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2349-6_5

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  • DOI: https://doi.org/10.1007/978-1-4939-2349-6_5

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  • Print ISBN: 978-1-4939-2348-9

  • Online ISBN: 978-1-4939-2349-6

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