To investigate any differences in thrombolytic treatment and subsequent intracranial hemorrhage between different neurology subspecialties performing telestroke encounters.

Telestroke encounters are critical telemedicine-based consults to facilitate emergent neurological evaluation of patients with potential stroke for acute treatment, such as intravenous thrombolysis (IVT). Given the growing need for neurologists nationwide, especially in rural regions, neurologists with and without additional vascular neurology fellowship training are needed to provide telestroke services. Acute stroke treatment is a required core training of neurology residencies; therefore, all graduate neurologists could potentially provide telestroke services.

Retrospective review of a prospectively maintained database of 3176 telestroke consults from January 2019 to February 2023, performed by vascular, general, and neuro-critical care (NCC) neurologists at a large rural comprehensive stroke center hub covering 31 spoke centers including rural critical access and primary stroke centers. Descriptive statistics was used to compare between neurology specialties performing telestroke encounters in rates of IVT treatment and symptomatic intracranial hemorrhage (sICH) after IVT. Chi square test was used to compare proportions between groups. P-values <.05 were considered statistically significant.

The 3176 telestroke consults were seen by neurologists specializing in vascular (38%), general (36%), and NCC (26%). In total, 23% of telestroke patients received IVT, with a 2% occurrence of sICH. There was no difference in rates of IVT treatment by provider type: vascular (23.3%), general (22.2%) and NCC (23.4%) (p=0.752). Similarly, no difference was seen in sICH rates by provider type.

These findings emphasize that telestroke consults can be safely and effectively performed by neurologists of various subspecialities, without reducing rates of IVT treatment or increasing rates of sICH. By expanding the pool of potential telestroke providers beyond vascular neurologists, more acute stroke patients can receive appropriate treatment, especially those patients in regions devoid of neurologists.