Journal Article Review Ahead of print
PubMed: 42630091 DOI: 10.1177/17474930261480603
Telestroke Care in Resource - Limited Settings: A World Stroke Organization (WSO) scientific statement.
Int J Stroke
Authors: Christine Tunkl, Leonardo Augusto Carbonera, Gordian Jan Hubert, Ayush Agarwal, Amelia Adcock, Bernardo Liberato, Laetitia Yperzeele, Tamer Roushdy, Maria Epifania Vasquez Collantes, Dulce MarĂa Bonifacio-Delgadillo, Christopher Bladin, Anna Ranta
Affiliations
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
- Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil.
- Center for Telemedicine, Department of Neurology, MĂ¼nchen Klinik GmbH, Munich, Germany.
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States.
- Marcus Stroke and Neurosciences Center - Grady Memorial Hospital, Emory University - School of Medicine, Atlanta, Georgia, USA.
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
- University of Philippines, Philippines General Hospital.
- Centro Medico ABC, Mexico.
- Victorian Stroke Telemedicine (VST) Service, Eastern Health Clinical School, Monash University.
- Department of Medicine, University of Otago, Wellington, New Zealand; Department of Neurology, Wellington Regional Hospital, Wellington, New Zealand.
Abstract
BACKGROUND
Telestroke services represent a crucial strategy for expanding access to acute stroke care in regions with limited local stroke expertise. However, existing recommendations and guidelines are predominantly derived from evidence generated in high-income countries and based on generally resource-intensive models. Such models and evidence may not be directly transferable to resource-limited settings. This Scientific Statement aims to summarize current knowledge on telestroke in resource-limited settings, highlight key considerations for establishing networks, and provide practical recommendations to guide future implementation and research.
METHODS
Evidence from a systematic literature review of telestroke networks in resource-limited settings was integrated with results of a structured survey and consensus-building process involving the World Stroke Organization (WSO) Telestroke Committee, who also served as the writing panel. Key domains relevant to the organization, setup, and quality assurance of telestroke services were identified and synthesized into pragmatic, context-sensitive recommendations.
RESULTS
The panel defines telestroke as a model of care that includes hyperacute decision-making, but also extends toward comprehensive stroke unit support. Recommendations are structured around essential and advanced components, covering organizational setup, technical requirements, clinical workflows, and quality assurance. Emphasis is placed on pragmatic, minimum viable solutions, suggesting adaptable technical configurations, standardized operating procedures, and feasible quality monitoring frameworks.
CONCLUSION
This statement provides practical guidance to support the safe and feasible implementation of telestroke services across diverse resource settings. Future research should focus on defining minimum effective models, evaluating individual components of telestroke systems, and addressing economic, regulatory, and cross-border implementation challenges. This scientific statement has been reviewed and approved by the WSO Executive.
MeSH
Stroke, Research