Loggini A, Schwertman A, Hornik J, Dallow K, Hornik A. Stroke metrics, safety, and outcomes of telemedicine-administered thrombolytics for acute ischemic stroke: A meta-analysis. World J Crit Care Med 2025; 14(4): 107570 [DOI: 10.5492/wjccm.v14.i4.107570]
Corresponding Author of This Article
Andrea Loggini, MD, MBA, Adjunct Assistant Professor, Brain and Spine Institute, Southern Illinois Healthcare, 405 W Jackson Street, Carbondale, IL 62901, United States. andrea.loggini@sih.net
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Neurosciences
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Meta-Analysis
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 9, 2025 (publication date) through Dec 9, 2025
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World Journal of Critical Care Medicine
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2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Loggini A, Schwertman A, Hornik J, Dallow K, Hornik A. Stroke metrics, safety, and outcomes of telemedicine-administered thrombolytics for acute ischemic stroke: A meta-analysis. World J Crit Care Med 2025; 14(4): 107570 [DOI: 10.5492/wjccm.v14.i4.107570]
World J Crit Care Med. Dec 9, 2025; 14(4): 107570 Published online Dec 9, 2025. doi: 10.5492/wjccm.v14.i4.107570
Stroke metrics, safety, and outcomes of telemedicine-administered thrombolytics for acute ischemic stroke: A meta-analysis
Andrea Loggini, Amber Schwertman, Jonatan Hornik, Karam Dallow, Alejandro Hornik
Andrea Loggini, Jonatan Hornik, Alejandro Hornik, Brain and Spine Institute, Southern Illinois Healthcare, Carbondale, IL 62901, United States
Andrea Loggini, Amber Schwertman, Department of Neurology, Southern Illinois University School of Medicine, Carbondale, IL 62901, United States
Karam Dallow, Department of Neurology, Southern Illinois University, Carbondale, IL 62901, United States
Author contributions: Loggini A was responsible for study concept, study design, data abstraction, data analysis, and drafting the manuscript; Schwertman A and Dallow K were responsible for data abstraction and data analysis; Hornik J was responsible for study design, data abstraction, data analysis, and drafting the manuscript; Hornik A was responsible for critical revision and approval of the final version of the manuscript.
Conflict-of-interest statement: None of the authors has any conflict of interest or financial disclosures to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andrea Loggini, MD, MBA, Adjunct Assistant Professor, Brain and Spine Institute, Southern Illinois Healthcare, 405 W Jackson Street, Carbondale, IL 62901, United States. andrea.loggini@sih.net
Received: March 26, 2025 Revised: April 11, 2025 Accepted: May 27, 2025 Published online: December 9, 2025 Processing time: 247 Days and 21.4 Hours
Abstract
BACKGROUND
Administration of thrombolytics for acute ischemic stroke (AIS) via telemedicine has expanded in recent years at institutions without on-site neurology specialists. This helped to improve the care of stroke patients in rural areas. However, it is uncertain if telemedicine-administered thrombolytics is as safe and effective as in-person evaluation by neurology specialists.
AIM
The authors conducted a meta-analysis evaluating stroke metrics, safety and outcomes of telemedicine compared to in-person evaluation by neurologist specialist in AIS patients receiving intravenous thrombolytics.
METHODS
PubMed, EMBASE, and Cochrane were searched for randomized clinical trials and observational cohort studies. The Mantel-Haenszel method or inverse variance, as applicable, were applied to calculate an overall effect estimate for each outcome by combining specific risk ratio (RR) or standardized mean difference (SMD). Risk of bias was analyzed using the Newcastle-Ottawa Scale. Primary outcome examined was door-to-needle time (DTN). Secondary outcomes were symptomatic intracranial hemorrhage (sICH), mortality, and mRS ≤ 2.
RESULTS
Eleven retrospective cohort studies involving 2350 patients were included in the analysis. Of those, 34% (n = 794) received thrombolytics via telemedicine. Telemedicine was associated with a significantly longer mean DTN compared to in-person evaluation [SMD: 0.72 minutes; 95% confidence interval (CI) 0.22-1.22; P < 0.01], a similar rate of sICH [3.9% vs 4.2%; Odds ratio (OR): 0.75; 95%CI 0.42-1.37; P = 0.35], similar rate of mortality (13.2% vs 14.7%; OR: 0.87; 95%CI 0.47-1.63; P = 0.67), and comparable rate of favorable short-term functional outcome (46.8% vs 50.7%; OR: 0.79; 95%CI 0.41-1.53; P = 0.48). Risk of bias was low to moderate for each outcome.
CONCLUSION
The available literature suggests that telemedicine is associated with longer DTN compared to in-person evaluation. This difference in stroke metric does not affect safety or outcome. Further studies are needed to understand and address the underlying factors of the longer DTN time.
Core Tip: In this meta-analysis, we compared telemedicine technology to in-person evaluation for the treatment of acute ischemic stroke, highlighting the differences in door-to-needle time (DTN) between the two modalities, and the impact of them on outcomes. The literature suggests that the stroke metric, in terms of DTN, is longer by telemedicine modality of evaluation. However, this difference does not translate in differences in safety and outcomes.
