Teleneurology vs On-Site Neurology Consultation for Postadmission Hospital Care of Stroke

Importance: Telestroke networks provide coverage of neurological expertise in rural areas. While most teleneurological consultations focus on acute stroke care in emergency departments, neurological expertise remains crucial in the subacute phase. However, teleneurological ward rounds have not yet been systematically investigated for feasibility and quality. Objective: To assess noninferiority of teleneurological ward rounds compared with conventional on-site ward rounds during subacute inpatient stroke care, focusing on adherence to guideline-based quality indicators. Design, Setting, and Participants: This prospective, multicenter, nonrandomized, noninferiority study was conducted at 15 primary care hospitals within 4 German telestroke networks from October 2022 to December 2024. Adults (18 years or older) hospitalized with suspected acute ischemic or hemorrhagic stroke or transient ischemic attack were eligible. A total of 1908 patients were screened. These data were analyzed from January 2025 to May 2025. Exposures: Patients received both a teleneurological and an on-site neurological ward round. Teleneurological ward rounds were performed by network neurologists via video consultation; on-site consultations were performed by local neurologists. Documentation from both consultations was evaluated by blinded external neurovascular experts. Main Outcomes and Measures: The primary outcome was complete fulfillment of 6 predefined, guideline-based quality domains: etiological classification, neurological examination, risk assessment, diagnostic recommendations, secondary prevention, and recommended aftercare. Noninferiority was defined as a maximum difference in proportions of correct assessments of 5 percentage points. Secondary outcomes included correctness of individual domains and expert quality ratings on a visual analoge scale. Results: A total of 518 patients were enrolled (median age, 71 years; 222 female [44%] and 296 male [56%]) and 501 were included in the final analysis. Complete adherence to all quality criteria was achieved in 92% (95% CI, 90%-94%) of teleneurological ward rounds compared with 54% (95% CI, 49%-58%) of on-site ward rounds (absolute difference, 38 percentage points; 90% CI, 34-42). Superiority of teleneurological ward rounds was consistent across all quality domains with the most pronounced differences observed for secondary prevention (absolute difference, 21% percentage points; 90% CI, 17-24). Conclusions and relevance: Teleneurological ward rounds in subacute stroke care were noninferior and even superior when compared with on-site consultations, with respect to guideline adherence across all quality domains. These findings support the integration of telemedicine into routine inpatient stroke care, particularly in regions with limited access to neurological expertise.