Abstract Body: Background: Telestroke has proven efficacy in improving clinical outcomes by providing rapid access to specialized stroke care, particularly in remote areas. However, the global implementation of telestroke networks remains uneven, with limited data on their structure and coverage outside of high-income countries (HICs).
Objective: This study aimed to provide a comprehensive overview of the global landscape of telestroke networks, highlighting disparities and underscoring the need for universal guidelines. We aimed to map the global telestroke landscape, characterize existing networks, and identify disparities in access, technological adoption, and quality monitoring practices across different regions.
Methods: We conducted a three-tiered identification process involving engagement with national stroke experts, stroke societies, and international authorities, supplemented by extensive literature and internet searches to identify providers involved in telestroke networks worldwide. A detailed 39-question survey was distributed to the leaders of identified telestroke networks, assessing their structural characteristics, operational processes, and quality monitoring practices.
Results: A total of 254 telestroke networks were identified across 67 countries (Figure 1), with 69% located in HICs. The response rate to our survey was 34%, with 88 networks from 31 countries providing detailed data. Our findings reveal significant disparities in the establishment and operation of telestroke networks. HICs predominantly host large, well-established networks, with robust technological infrastructures and comprehensive quality monitoring. In contrast, networks in low- and middle-income countries (LMICs) are fewer, smaller, and often lack advanced technology and standardized quality assurance measures. Notably, 87% of networks established within the last three years are located in non-HIC regions, signaling a shift toward broader global implementation.
Conclusion: This study provides one of the most comprehensive global mappings of telestroke networks to date, uncovering significant disparities in access, resources availability (Figure 2) and quality monitoring practices. While telestroke networks are expanding into LMICs, there remains a critical need for universally applicable guidelines that can be adapted to diverse resource settings.