Telemedicine in the management of acute stroke:systematic review and meta-analysis of the literature

Background Acute ischemic stroke (AIS) is a leading cause of death and disability and recombinant tissue plasminogen activator (tPA) may significantly reduce the long-term impact if given timely. A rapid assessment of the patient is therefore required. Notwithstanding many hospitals lack the stroke expertise and resources to timely manage patients. In this context, telemedicine facilities could be useful. The aim of this study was to perform a systematic review and meta-analysis to assess if telemedicine can be used in order to manage patients with AIS with a specific focus on the impact on mortality. Methods Longitudinal studies dealing with telemedicine facilities in managing AIS conducted before April 15th 2014 and published in English were searched in PubMed, Web of Knowledge and Scopus. The meta-analysis was performed to assess the impact of telemedicine versus standard approach in reducing mortality. Relative risk (RR) with 95% Confidence Interval was used to report results and the I2 to evaluate heterogeneity. Results Six studies were considered for the review for a total of 3,987 patients managed by either telemedicine (2,283) or standard approach (1,704). Four articles were clinical trials and two were cohort studies. Three studies addressed in-hospital mortality while all six dealt with 90 days mortality. The meta-analysis yielded a RR of 1.68 (95% CI 0.68–4.10) and 0.96 (95% CI 0.83–1.11) for in-hospital mortality and 90 days mortality respectively, without heterogeneity. A subgroup analysis considering only trials released a RR of 0.72 (95% CI 0.14–3.58) and of 0.94 (95% CI 0.81–1.10) respectively. Conclusion Our review showed no significant differences in terms of mortality between telemedicine and control groups even though results may be not considered conclusive because of the small number of studies. Because of these results and in the light of current organizational shortages, telemedicine may be used in order to manage patients with AIS. Key messages Telemedicine does not improve survival of patients with acute ischemic stroke as no significant differences were shown in-hospital and 90 days mortality between telemedicine and standard approach Telemedicine is as an important tool in order to overcome organizational shortage but its impact on patients’ health outcomes deserves to be further addressed by appropriate studies