Teleneurological Ward Rounds Noninferior to On-Site Care in Subacute Stroke Patients
Key Clinical Summary
- Teleneurological ward rounds in subacute stroke care were found noninferior to on-site consultation based on 6 guideline-based quality domains, according to a prospective study in Germany.
- Complete fulfillment of 6 quality criteria was achieved in 92% of teleneurological ward rounds compared to 54% of on-site ward rounds.
- Teleneurological ward rounds were superior across all quality domains, with the most significant difference observed in secondary prevention (absolute difference, 21 percentage points; 90% CI, 17-24).
Teleneurological ward rounds were found noninferior to conventional on-site ward rounds in subacute inpatient stroke care, according to prospective study findings published in JAMA Neurology. Conducted across 15 primary care centers in Germany, the study suggests that telehealth services may help expand access to specialized neurological support.
Study Findings
The nonrandomized, noninferiority study enrolled 518 patients who were 18 years or older and hospitalized with suspected acute ischemic or hemorrhagic stroke or transient ischemic attack (median age, 71 years; 44% female). Patients were recruited from 15 primary care hospitals within 4 telestroke networks in Germany.
All patients received both on-site and virtual neurological ward rounds, which were performed by local neurologists and network neurologists via video consultation respectively. Documentation from each of the consultations was assessed by blinded external neurovascular experts for the fulfillment of 6 guideline-based quality domains: etiological classification, neurological examination, risk assessment, diagnostic recommendations, secondary prevention, and recommended aftercare.
Documentation was also evaluated for the correctness of individual domains and expert quality ratings on a visual analogue scale.
In the final analysis of 501 patients, complete fulfillment of all quality criteria was achieved in 92% (95% CI, 90%-94%) of teleneurological ward rounds compared to 54% (95% CI, 49%-58%) of on-site ward rounds, yielding an absolute difference of 38 percentage points (90% CI, 34-42). Teleneurological ward rounds were superior across all quality domains, with the most significant difference observed in secondary prevention (absolute difference, 21 percentage points; 90% CI, 17-24).
Clinical Implications
The study’s findings suggest that telemedicine-based consultations can be leveraged for effective subacute inpatient stroke care. This may be particularly useful in rural areas or regions with limited access to neurological expertise.
However, the authors noted that the study was limited by its observational nature. The direct impact of teleneurological consultations on clinical outcomes was not established, warranting additional research.
Expert Commentary
“The VISIT STROKE study demonstrates that telemedicine-based neurological ward rounds provide high-quality, guideline-adherent care and may outperform conventional on-site ward rounds in the postacute management of stroke patients,” wrote Janina R. Behrens, MD, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, and study coauthors.
Still, the authors concluded that “the value of in-person neurological presence for fostering team communication, education, and patient-centered interactions…should not be underestimated.”
