Table 2.

Methodology and Findings Pertaining to Stroke

LITERATURE SOURCE			METHODOLOGY				FINDINGS
REFERENCE	DATE	COUNTRY	DESIGN	SIZE (N)	DURATION (MONTHS)	TELEMEDICINE TECHNOLOGY	FEASIBILITY AND RELIABILITY	EVENT TIMINGa	HEALTH OUTCOMESb	COMMENTS
Khan et al.82	2010	Canada	PCC	210	24	T	Yes	↑	O	No difference between T and VTC
						VTC		↑
Gonzalez et al.83	2011	United States	PCC	960	NR	CVP	Yes	↓	O	38 seconds longer than bedside
Demaerschalk et al.84	2012	United States	PCC	100	NR	Network	Yes	NM	O	NIHSS: 8 high, 6 moderate, 1 poor agreement (ataxia)
Allibert et al.85	2012	France	RCC	161	72	VTC	Yes	NM	O	LOS shorter
Pervez et al.86	2010	United States	RR	296	3/6	T, VTC	Yes	↑	O	“Drip and ship” is safe/effective; spoke patients less severe
Spokoyny et al.87	2014	United States	RCT	261	NR	T, VTC	Yes	NM	↑	Telestroke evaluation of head CT scans for acute tPA assessments is reliable.
Demaerschalk et al.88	2012	United States	2 RCTs	276	3	T, VTC	VTC better	↑	VTC>T	VTC higher sensitivity than phone
Handschu et al.89	2008	Germany	PCC	151	12	T, VTC	Yes	VTC↓; T↑	↑	Exam times (VTC, 49.8 minutes/T, 27.2 minutes)
Puetz et al.90	2012	Germany	PCC	536	NR	Network	Yes	NM	↑	Stroke neurologists can reliably interpret CT scans.
Müller et al.91	2006	Germany	PCC/RCC	299	24	VTC	Yes	NM	↑	All quality indicators improved; LOS lower
Audebert et al.92	2009	Germany	NR	267	3	VTC	Yes	↑	O	Acceptance high and stable
Pedragosa et al.93	2009	Spain	RCC/PCC	201	12	VTC	Yes	↑	↑	Telemedicine allowed 38% (from 17%) neurologist evaluation
Nagao et al.94	2012	Australia	RR	275	12	VTC	Yes	↑	O	Telestroke faster, safe, reliable
Sairanen et al.95	2011	Finland	PCC	985	24	VTC	Yes	↑	O	On-site versus telestroke similar results
Rudd et al.96	2014	United Kingdom	RCC	2,922	36	T	Yes	T ↓	O	In-person 65 minutes, T 73 minutes
Bruno et al.97	2013	United States	RR	889	20	VTC	Yes	↑	↑	Registration delay (median 39 minutes)
Pedragosa et al.98	2012	Spain	PCC	119	24	VTC	↑ Endovascular treatment	↑	↑	Saved time in endovascular treatment
Walter et al.99	2012	Germany	RCT	100	Stopped at 100 patients	MSU	MSU feasible/reliable	↑	O	Timing improved
Audebert et al.100	2009	United Kingdom	PCC	3,060	12/24	VTC	Yes	↑	↑	Long-term benefit for acute stroke patients
Theiss et al.101	2013	Germany	LS	1,152	48	VTC	Yes	↑	↑	Increased teleconsultations and 45% increase in protocol conformity
Switzer et al.102	2013	United States	PCC	1,112	60	VTC	Yes	↑	↑	Spoke hospitals more effectively used

^aArrows indicate direction of change: faster or increased use (↑) or slower or decreased use (↓).

^bArrows indicate direction of change: improved (↑) or declined (↓).

CT, computed tomography; CVP, cellular videophone; LS, longitudinal study; MSU, mobile stroke unit with computed tomography scanner; NIHSS, National Institutes of Health Stroke Scale; NM, not measured; NR, nonrandomized; O, neutral outcome; PCC, prospective case control; RCC, retrospective case control; RCT, randomized controlled trial; RR, retrospective review; T, telephone; t-PA, tissue plasminogen activator; VTC, video teleconference.