JMIR Publications

ABSTRACT

Background:

Acute ischemic stroke (AIS) management in rural regions is challenged by interhospital transfer delays, impacting outcomes.

Objective:

This study evaluates the efficacy of video-conferencing teleconsultation on improving transfer efficiency and clinical outcomes in a hub-and-spoke model.

Methods:

This retrospective cohort study (January 2022–December 2024) included AIS patients identified as potential EVT candidates, transferred from a primary stroke center (PSC) to a comprehensive stroke center (CSC). Patients were categorized into teleconsultation and standard referral process (SRP) groups. The primary outcome was door-in-door-out (DIDO) time, with additional analyses on its components. Secondary outcomes included stroke-related decision-making and 90-day functional outcome using modified Rankin Scale (mRS). Safety outcomes included all-cause mortality within 90 days and symptomatic intracranial hemorrhage after intravenous thrombolysis and/or EVT.

Results:

A total of 83 patients were included, with 41 in the teleconsultation group and 42 in the SRP group (mean age: 73.3 years), and baseline characteristics were comparable. Teleconsultation significantly reduced DIDO time (95.2±22.9 vs. 132.3±41.5 minutes, p<0.001) by shortening CTA-to-ambulance notification time (44.6±17.4 vs. 79.5±37.6 minutes, p<0.001). Teleconsultation group had higher intravenous thrombolysis rates at the PSC (63.4% vs. 40.5%, p=0.04), higher EVT rates (34.2% vs. 14.3%, p=0.035) and shorter door-to-puncture time (83.0±35.5 vs. 118.5±25.9 minutes, p=0.04) at the CSC, with a significant shift toward better mRS at 90th day (OR: 4.55, p<0.001 vs. OR: 1.35, p=0.07). Safety outcomes were comparable between groups.

Conclusions:

Video-conferencing teleconsultation improves interhospital transfer efficiency, stroke-related decision-making, and functional outcomes. This study highlights its potential in optimizing rural stroke care.