Evidence map›Paper›PMID 41004145›Full record

ArticleJAMA network open2025

Telestroke and Timely Treatment and Outcomes in Patients With Acute Ischemic Stroke.

Brian Stamm, Rachael T Whitney, Regina Royan, Ghada Ibrahim, Adrienne V Nickles, Rebecca A Ferber, Wen Ye, Wan-Ling Hsu, Nikita Chhabra, Rodney A Hayward and 5 more

Abstract read
In one paragraph

Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
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  5. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Brian StammDepartment of Neurology, University of Michigan, Ann Arbor.
Rachael T WhitneyDepartment of Internal Medicine, University of Michigan, Ann Arbor.
Regina RoyanDepartment of Neurology, University of Michigan, Ann Arbor.
Ghada IbrahimMichigan Department of Health and Human Services, Lansing.
Adrienne V NicklesMichigan Department of Health and Human Services, Lansing.
Rebecca A FerberDepartment of Internal Medicine, University of Michigan, Ann Arbor.
Wen YeDepartment of Biostatistics, University of Michigan School of Public Health, Ann Arbor.
Wan-Ling HsuDepartment of Internal Medicine, University of Michigan, Ann Arbor.
Nikita ChhabraDepartment of Neurology, University of Michigan, Ann Arbor.
Rodney A HaywardInstitute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
Mollie McDermottDepartment of Neurology, University of Michigan, Ann Arbor.
Phillip A ScottDepartment of Emergency Medicine, University of Michigan, Ann Arbor.
Kevin N ShethCenter for Brain and Mind Health, Departments of Neurology and Neurosurgery, Yale School of Medicine, Yale University, New Haven, Connecticut.
Mathew J ReevesDepartment of Epidemiology and Biostatistics, Michigan State University, East Lansing.
Deborah A LevineDepartment of Neurology, University of Michigan, Ann Arbor.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Telestroke has the potential to revolutionize acute stroke treatment by improving access to optimal stroke care, including time-sensitive care such as thrombolysis. However, it is unclear how treatment times and stroke outcomes compare between patients evaluated and not evaluated by telestroke. Objective: To evaluate the association between telestroke use and acute stroke treatment times and outcomes. Design, Setting, and Participants: This retrospective cohort study included patients with acute ischemic stroke aged 18 years or older presenting to 42 Paul Coverdell Michigan Stroke Registry hospitals from January 1, 2022, to December 31, 2023. All patients were potentially eligible for thrombolysis (ie, presented ≤4 hours of last known well, no contraindications to thrombolysis documented). Exposure: Telestroke (vs nontelestroke) encounter. Main Outcomes and Measures: The primary outcomes were receipt of thrombolysis and door-to-needle (DTN) time as a continuous variable and a categorical variable (≤60 vs >60 minutes). Secondary outcomes included discharge ambulatory status, discharge destination, and door-in-door-out (DIDO) time in transferred patients. Multivariable hierarchical models evaluated associations between telestroke (vs nontelestroke) activation and outcomes, sequentially adjusting for demographics, medical history, presentation or arrival, and hospital characteristics. Results: Among the 3036 patients with acute ischemic stroke potentially eligible for thrombolysis (mean [SD] age, 69.7 [14.5] years; 1563 male [51.5%]), 785 (25.9%) were evaluated using telestroke and 2251 (74.1%) without telestroke. A total of 1673 patients (55.1%) were treated with thrombolysis. In the fully adjusted models, patients evaluated by telestroke had a significantly higher odds of receiving thrombolysis (adjusted odds ratio, 1.61; 95% CI, 1.17-2.23) but longer DTN times (6.55 minutes longer; 95% CI, 2.12-10.97 minutes longer) and lower odds of meeting a guideline-concordant DTN time within 60 minutes (adjusted odds ratio, 0.56; 95% CI, 0.39-0.81) compared with those not evaluated by telestroke. Among 255 patients who underwent interhospital transfer, 207 (81.2%) received thrombolysis, and patients with telestroke had significantly longer DIDO times (46.90 minutes longer, 95% CI, 1.08-92.72 minutes longer). Conclusions and Relevance: In this cohort study of patients with acute ischemic stroke potentially eligible for thrombolysis, those evaluated by telestroke had a 61% higher odds of receiving thrombolysis but a 44% lower odds of meeting guideline-concordant DTN times within 60 minutes and prolonged DIDO times compared with those not evaluated by telestroke. Future research should investigate modifiable factors that contribute to treatment delays in patients with ischemic stroke evaluated via telestroke.

Indexed as

Ischemic StrokeTelemedicineThrombolytic TherapyTime-to-TreatmentAgedAged, 80 and overFemaleHumansMaleMichiganMiddle AgedRegistriesRetrospective StudiesTreatment Outcome

Identifiers

PMID41004145
PMCPMC12475942

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.