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Publications

Journal Article Epublish

PubMed: 42698418 DOI: 10.3389/fstro.2026.1879025

Quality monitoring in telestroke networks: real-world insights from survey response data and literature review.

Front Stroke 5:1879025

Authors: Ayush Agarwal, Christine Tunkl, Alexandra Krauss, Emily R Ramage, Mirjam R Heldner, Stefan T Gerner, Teresa Ullberg, Leonardo A Carbonera, Jatinder S Minhas, Aristeidis Katsanos, Matias J Alet, Abdul H K Y Khan, Faddi Saleh Valez, Tamer Roushdy, Linxin Li, Bogdan Ciopleias, Zhe Kang Law, Radhika Lotlikar, Susanna M Zuurbier, Maria G Mosconi, Shirsho Shreyan, Shakti Shrestha, Gisele S Silva, Annemarei Ranta

Affiliations

  • Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
  • Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
  • Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.
  • Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
  • Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
  • Department of Neurology, Skane University Hospital, Lund University, Lund, Sweden.
  • Department of Neurology and Neurosurgery, MOVE Academic Research Organization, Hospital Moinhos de Vento, Porto Alegre, Brazil.
  • NIHR Leicester Biomedical Research Centre, Division of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
  • Department of Medicine (Neurology), McMaster University and Population Health Research Institute, Hamilton, ON, Canada.
  • Department of Neurology, Comprehensive Stroke Center, Fleni, Buenos Aires, Argentina.
  • Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
  • Department of Neurology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
  • Neurology department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
  • Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
  • Department of Neurology, Faculty of Medicine, Transilvania University, BraÈ™ov, Romania.
  • Neurology Unit, Department of Medicine, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Kuala Lumpur, Malaysia.
  • Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.
  • Department of Neurology, Antwerp University Hospital, Edegem, Belgium.
  • Internal Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
  • Rajshahi Medical College, Rajshahi, Bangladesh.
  • School of Pharmacy and Pharmaceutical Sciences, The University of Queensland, Brisbane, QLD, Australia.
  • Departamento de Neurologia da Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
  • Department of Medicine, University of Otago, Dunedin, New Zealand.
  • Department of Neurology, Wellington Hospital, Wellington, New Zealand.

Abstract

BACKGROUND AND AIMS

The objective of telestroke services is to enhance the quality of stroke care delivered to remote locations. The American Heart Association/ American Stroke Association (AHA/ASA) and the European Stroke Organization (ESO) have issued recommendations for quality monitoring in telestroke. To provide real-world insights, our study analyzed data on quality monitoring practices among telestroke networks.

METHODOLOGY

This is a secondary analysis of a global telestroke survey previously conducted by our group. The focus of the current analysis was on reported quality metrics. We also reviewed articles from our prior systematic review (SR) of the literature on telestroke networks to extract quality metrics from published data and compared these with those reported in survey responses.

RESULTS

Eighty-eight of 254 networks responded to the survey. The SR analyzed 92 studies describing 64 acute telestroke networks across 17 countries. Quality monitoring was performed in 64 of 88 surveyed networks (72%), and it was described in all networks identified in the published literature. The most frequently reported performance indicator across both data sources was thrombolysis rate (93% in survey, 87% in SR). Other recommended indicators were reported less frequently in both the survey and the SR, with recanalization rate reported as 54% vs. 35%, discharge NIHSS as 65% vs. 1%, and in-hospital mortality as 78% vs. 31%, respectively.

CONCLUSION

Our study is the first real-world insight into the state of quality monitoring in telestroke, both from peer-reviewed literature and self-reported data. The observed heterogeneity and low uptake of recommended quality indicators highlight the potential need for consensus on a standardized minimal quality monitoring dataset to facilitate feasible quality monitoring and comparison of outcomes across networks.

MeSH

Stroke, Hospital Mortality