A Case for the Non-Neurologist Telestroke Provider.

Area of Science:

• Neurology
• Telemedicine
• Emergency Medicine

Background:

• Telestroke networks improve acute stroke therapy access for ischemic stroke patients.
• Dedicated stroke subspecialists may not always be available in telestroke settings.

Purpose of the Study:

• To compare the efficacy and safety of telestroke consultations performed by neurologists versus emergency medicine physicians.
• To assess differences in tPA recommendation rates, diagnostic accuracy, and hemorrhagic complications.

Main Methods:

• Retrospective review of 303 telestroke consults over one year at a comprehensive stroke center.
• Statistical analysis using the Chi-squared test to compare outcomes between provider groups.
• Categorization of providers into emergency medicine, non-stroke-trained neurologists, and vascular neurologists.

Main Results:

• No statistically significant difference in tPA recommendation rates between emergency medicine physicians (38%) and neurologists (40%).
• Similar sensitivity for final stroke diagnosis between emergency medicine (77%) and neurology (72%) providers.
• No symptomatic hemorrhagic complications post-tPA; one asymptomatic intracerebral hemorrhage observed in the neurology group.

Conclusions:

• Emergency medicine physicians provide comparable care to neurologists in telestroke consultations for acute stroke therapy.
• The availability of experienced non-neurologist providers can facilitate sustainable telestroke network implementation.
• Lack of formally trained neurologists should not hinder the development of effective telestroke programs.