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Abstract
Background: The use of 2-way audiovisual (AV) technology for delivery of acute stroke evaluation and management, termed “telestroke,” is supported by a rapidly growing literature base. A systematic review that provides a comprehensive, easily digestible overview of telestroke science and practice is lacking. Purpose: To conduct a systematic review of the published literature on telemedical consultation for the purposes of providing acute stroke evaluation and management. Data Sources: The Ovid Medline, Embase, PsychINFO, CINAHL, PubMed, and Cochrane databases were searched with numerous keywords relevant to telestroke from January 1996 through July 2012. Study Selection: Studies were included if the title or abstract expressed use of 2-way AV communication for acute stroke evaluation and management. Data Extraction: Each article was classified using a novel scoring rubric to assess the level of Functionality, Application, Technology, and Evaluative stage (FATE). Data Analysis: The search yielded 1405 potentially eligible articles, which were independently reviewed by 2 investigators. There were 344 unique studies that met eligibility criteria and underwent full–text review. Ultimately, 145 unique studies underwent FATE assessment and scoring. Results: Most telestroke studies evaluated functionality in the context of acute stroke assessment of adults in emergency departments. Nearly half of all published articles on telestroke were narrative reviews. After exclusion of these reviews, the median FATE score for telestroke primary data was 4. Conclusion: Telestroke technology is now part of mainstream clinical stroke practice in North America and internationally. Telestroke reliability, validity, efficacy, safety, clinical, and cost–effectiveness studies reflect maturity in the field, and new post–implementation studies in the pre–hospital setting present welcome and sophisticated advancements in the field.