{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:05:47Z","timestamp":1792807547223,"version":"4.5.0"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association between telestroke use and acute stroke treatment times and outcomes.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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 \u22644 hours of last known well, no contraindications to thrombolysis documented).<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Telestroke (vs nontelestroke) encounter.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were receipt of thrombolysis and door-to-needle (DTN) time as a continuous variable and a categorical variable (\u226460 vs &amp;gt;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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.34275","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T15:30:37Z","timestamp":1758900637000},"page":"e2534275","source":"Crossref","is-referenced-by-count":13,"title":["Telestroke and Timely Treatment and Outcomes in Patients With Acute Ischemic Stroke"],"prefix":"10.1001","volume":"8","author":[{"given":"Brian","family":"Stamm","sequence":"first","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"},{"name":"VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan"},{"name":"Geriatric Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael T.","family":"Whitney","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Royan","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"},{"name":"Department of Emergency Medicine, University of Michigan, Ann Arbor"},{"name":"Assistant Editor, JAMA Network Open"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghada","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Michigan Department of Health and Human Services, Lansing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne V.","family":"Nickles","sequence":"additional","affiliation":[{"name":"Michigan Department of Health and Human Services, Lansing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A.","family":"Ferber","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan-Ling","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Chhabra","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney A.","family":"Hayward","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"},{"name":"VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan"},{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mollie","family":"McDermott","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip A.","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin N.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Center for Brain and Mind Health, Departments of Neurology and Neurosurgery, Yale School of Medicine, Yale University, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew J.","family":"Reeves","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Michigan State University, East Lansing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah A.","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"},{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"issue":"23","key":"zoi250960r1","doi-asserted-by":"publisher","first-page":"2480","DOI":"10.1001\/jama.2013.6959","article-title":"Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic 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