ESOC 2025 | Findings from the MSU-TELEMED trial of telemedicine neurologist assessments on a mobile stroke unit

Keeping in line with the limitations of a mobile stroke unit, there’s been some recent modeling that suggests that a telemedicine neurologist, so keeping the neurologist at a home hospital and utilizing telemedicine, could be a more cost-effective approach compared to a traditional on-board model. And so after this point, there is variable use of telemedicine throughout mobile stroke units in the world, but there’s never been a head-to-head comparison of a telemedicine model to an on-board model. And even though telemedicine models may be more cost-effective, we want to ensure that they’re just as safe and just as effective in providing timely delivery of care. So the MSU-TELEMED trial is the first major comparison of a telemedicine model of care to an on-board model in a mobile stroke unit. So it’s a prospective randomized open-label blinded endpoint trial that took place on the Melbourne mobile stroke unit and with 10 tertiary care hospitals in Melbourne, Australia. And so patients presenting within 24 hours with symptoms suggestive of a stroke who received a full assessment from the MSU were enrolled into the trial. And basically the two arms are the telemedicine arm where patients are being assessed remotely by a neurologist who’s staying at the home hospital. The rest of the MSU team is assessing the patient in person. And then the on-board arm is a neurologist being with the team and seeing the patient in person and assessing the patient in person. And then we performed our randomization in the course of days. So days on the truck versus days off the truck. And what we did that was a bit unique about this trial is because we wanted to look at resource utilization, but also making sure that care was safe and timely, we used a hierarchical primary outcome. So we actually had three levels of our primary outcome. The first being safety, the second being time to decision, and the third being resource utilization. And we compared every patient on the telemedicine arm to the on-board arm and utilized the win odds approach to calculate and to account for safety, time to delivery, and resource utilization. And our primary outcome indicates that from a safety standpoint, there was no difference in safety in terms of negative safety events between telemedicine and on-board. In the on-board arm, we did see a slightly increased time to decision in the telemedicine arm compared to the on-board arm. But overall, when it came to resource utilization, there was significantly more efficient utilization of telemedicine resources in the telemed arm versus the on-board arm. And so what we found ultimately was that the telemedicine arm was more resource efficient, but still safe and not having any major differences in timely delivery of care. And so that was our sort of key primary outcome. And when we looked at our subgroups, we found that that primary outcome was consistent. And when we looked at 90-day outcomes for those patients that were treated with thrombolysis or endovascular therapy on the mobile stroke unit, we did not see any major differences in 90-day outcomes as well. And so we were able to achieve our sort of major goal of showing that a telemedicine model on a mobile stroke unit can be just as safe, just as effective in providing care and more resource efficient.

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