title: Telemedicine in acute stroke management: systematic review.
abstract: OBJECTIVE
  Stroke is the third largest cause of death and a major factor in permanent disability. Disparities in access to healthcare services exist due to geographical barriers and limited resources. Rural locations often lack the resources for adequate acute stroke care. Telestroke is intended to enable the transfer of knowledge of acute stroke management to areas with limited neurological services. The objective of this study is to assess the feasibility, acceptability, and treatment delivery reliability of telemedicine systems in acute stroke management.
  
  
  METHODS
  A systematic review was undertaken.
  
  
  RESULTS
  Eighteen studies were included in this systematic review. Telestroke services have been reported to lead to better functional health outcomes, including reduced mortality and dependency, compared with conventional care. Most studies report that systemic tissue plasminogen activator (tPA) treatment increased in hospitals providing telestroke services, although patients were often transferred to a stroke center for continuing monitoring and surveillance. Patients and healthcare providers reported high levels of satisfaction. There was limited evidence regarding the impact on resource utilization and cost-effectiveness.
  
  
  CONCLUSIONS
  Telemedicine systems can be safe, feasible, and acceptable in acute stroke management. Telestroke is associated with increased delivery of tPA. The lack of standardized measuring and reporting of resources and health outcomes hinder comparisons between telestroke networks and the determination of best practices. More research is needed to explore the clinical and economic impact of telemedicine technologies in acute stroke management, so as to support policy makers in making informed decisions.
authors.affiliation: Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria. tim.johansson@hta.lbg.ac.at
authors.forename: Tim
authors.initials: T
authors.lastname: Johansson
authors.forename: Claudia
authors.initials: C
authors.lastname: Wild
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D017216:Telemedicine / Q000191:economics; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator