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. 2025 Mar;20(3):297-309.
doi: 10.1177/17474930241298450. Epub 2024 Nov 15.

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

Christine Tunkl  1 , Ayush Agarwal  2 , Emily Ramage  3 , Faddi Saleh Velez  4 , Tamer Roushdy  5 , Teresa Ullberg  6 , Linxin Li  7 , Leonardo A Carbonera  8 , Abdul Hanif Khan Yusof Khan  9 , Bogdan Ciopleias  10 , Zhe Kang Law  11 , Aristeidis H Katsanos  12 , Mirjam R Heldner  13 , Maria Khan  14 , Sarah Matuja  15 , Matias J Alet  16 , Javier Lagos-Servellón  17 , Jatinder S Minhas  18   19 , Susanna M Zuurbier  20 , Maria Giulia Mosconi  21 , Radhika Lotlikar  22 , Ahmed Elkady  23 , Stefan T Gerner  24 , Shirsho Shreyan  25 , Alexandra Krauss  1 , Christoph Gumbinger  1 , Padma Srivastava  2 , Pawel Kiper  26 , Robin Ohannessian  27 , Anne Berberich  28 , Gisele Sampaio Silva  29   30 , Anna Ranta  31
Affiliations

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

Christine Tunkl et al. Int J Stroke. 2025 Mar.

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.

Keywords: Telestroke; guidelines; healthcare implementation; networks; stroke.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: L.A.C. reports receiving a limited grant from the World Stroke Organization and the Angels Initiative/Boehringer Ingelheim and consulting, speaker, or travel fees from Allm, AstraZeneca, Boehringer Ingelheim, ISchemaView, and Servier outside of this work. J.S.M. is funded by a Stroke Association Clinical Lectureship (SA SCLM23\100003). This investigator is supported by the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NIHR, Stroke Association or the Department of Health and Social Care.

Figures

Figure 1.
Figure 1.
Telestroke network identification process.
Figure 2.
Figure 2.
Global coverage of acute telestroke networks.
Figure 3.
Figure 3.
Comparison of identified telestroke networks and survey responses in percentage by (a) World Bank country classification by income level and (b) GBD super-region. Number of networks in percentage. GBD: Global Burden of Disease; HIC: high-income countries; UMIC: upper-middle income countries; LMIC: lower-middle income countries; LIC: low-income countries; EURCA: Central Europe, Eastern Europe and Central Asia; LatAm: Latin America and the Caribbean; SEARO: South-East-Asia and Oceania; MENA: Middle-East and North-Africa; SA: South-Asia; SSA: sub-Saharan Africa.
Figure 4.
Figure 4.
Components of a telestroke consultation. IT: imaging transfer; RTVE: real-time-video examination; VC: voice call; Docu: written documentation; Message: text messaging.
See this image and copyright information in PMC

References

    1. Meyer BC, Raman R, Hemmen T, et al.. Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. Lancet Neurol 2008; 7: 787–795. - PMC - PubMed
    1. Schwamm LH, Holloway RG, Amarenco P, et al.. A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke 2009; 40: 2616–2634. - PubMed
    1. Audebert HJ, Schenkel J, Heuschmann PU, Bogdahn U, Haberl RL. and Telemedic Pilot Project for Integrative Stroke Care Group. Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany. Lancet Neurol 2006; 5: 742–748. - PubMed
    1. Mohamed A, Elsherif S, Legere B, Fatima N, Shuaib A, Saqqur M. Is telestroke more effective than conventional treatment for acute ischemic stroke? A systematic review and meta-analysis of patient outcomes and thrombolysis rates. Int J Stroke 2024; 19: 280–292. - PMC - PubMed
    1. Tunkl C. Structure, process and outcomes of telestroke networks worldwide—what literature tells us. In progress 2024.