What is the clinical evidence from this study?

Study design: RCT. Population: suspected stroke (n=275). Intervention: Telemedicine neurologist model of care vs. Onboard neurologist model of care. Primary outcome: hierarchical composite outcome prioritizing safety, scene-to-treatment-decision time, and percentage of total case time the neurologist spent in direct care (adjusted win odds 3.5, 95% CI 2.4-5.1).

What does this research mean for the field?

A telemedicine neurologist model on a mobile stroke unit is superior to an onboard neurologist model based on a hierarchical composite outcome of safety, scene-to-treatment-decision time, and neurologist direct care utilization. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To directly evaluate the clinical safety, decision speed, and resource efficiency of a telemedicine neurologist model compared to an onboard neurologist model in mobile stroke units.

December 22, 2025NEJM Evidence

A Randomized Trial of Telemedicine Models of Care on a Mobile Stroke Unit

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Key result

Telemedicine neurologist on mobile stroke units improves composite outcomes with ~3.5-fold higher win odds.

adjusted win odds 3.5
95% CI 2.4-5.1
n=275

Why the study?

Does a telemedicine neurologist care model improve a hierarchical composite of safety, decision time, and neurologist time utilization compared to an onboard neurologist model in patients presenting to a mobile stroke unit with suspected stroke?

Population

275 participants presenting to a mobile stroke unit (MSU) with suspected stroke

Comparison

Telemedicine neurologist care model vs Onboard neurologist care model

Design

RCT, prospectively randomized by day, open-label, blinded-endpoint

Authors

VYVignan YogendrakumarThe Royal Melbourne Hospital ABAnna H. BalabanskiThe Royal Melbourne Hospital HJHannah JohnsThe Royal Melbourne Hospital

Discussion

Member takes

Implication

A telemedicine model of care on mobile stroke units optimizes neurologist resource utilization without compromising safety compared to an onboard neurologist model.

Key Points

To directly evaluate the clinical safety, decision speed, and resource efficiency of a telemedicine neurologist model compared to an onboard neurologist model in mobile stroke units.
Randomized, open-label, blinded-endpoint trial (MSU-TELEMED; NCT05991310) involving 275 participants presenting with suspected stroke, randomized by day to onboard (n=140) or telemedicine (n=135) neurologist care.
The primary endpoint was a hierarchical composite outcome analyzed with a win-odds framework prioritizing: (1) safety, (2) scene-to-treatment-decision time, and (3) percentage of case time spent in direct patient care.
The primary composite outcome favored the telemedicine model with a win/tie/loss distribution of 76%/4%/20% and an adjusted win odds of 3.5 (95% CI, 2.4–5.1).
Safety events were balanced between arms, occurring in 13% of the telemedicine group versus 12% of the onboard group (risk ratio, 0.9; 95% CI, 0.5–1.8).
Median scene-to-treatment-decision time was 19 minutes for telemedicine versus 13 minutes for onboard care (adjusted difference, 4 minutes; 95% CI, 1.9–5.9), while median neurologist direct care time was 100% versus 33% (adjusted difference, 63 percentage points; 95% CI, 53–74).

Study Design

Type

RCT (n=275)

Blinding

open-label, blinded-endpoint

Randomization

prospectively randomized by day

Structured PICO

Population

275 participants presenting to a mobile stroke unit with suspected stroke.

Intervention

Telemedicine neurologist care model

Comparator

Onboard neurologist care model

Outcome

Hierarchical composite outcome using a win-odds approach prioritizing: (1) safety, (2) scene-to-treatment-decision time, and (3) percentage of the total case time the neurologist spent in direct carecomposite

Main Result

Odds Ratio: 3.5 (95% CI 2.4–5.1)

Absolute Event Rate: 76% vs 20%

A telemedicine model of care on mobile stroke units optimizes neurologist resource utilization without compromising safety compared to an onboard neurologist model.

Cite This Study

Yogendrakumar et al. (2025) conducted an RCT in suspected stroke (n=275). Telemedicine neurologist model of care vs. Onboard neurologist model of care was evaluated on hierarchical composite outcome prioritizing safety, scene-to-treatment-decision time, and percentage of total case time the neurologist spent in direct care (adjusted win odds 3.5, 95% CI 2.4-5.1). A telemedicine neurologist model on a mobile stroke unit was superior to an onboard model based on a hierarchical composite outcome (adjusted win odds 3.5; 95% CI, 2.4-5.1).

synapsesocial.com/papers/6a110cfa6da19daf83169ac8 https://doi.org/10.1056/evidoa2500217

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Implication

A telemedicine model of care on mobile stroke units optimizes neurologist resource utilization without compromising safety compared to an onboard neurologist model.

A Randomized Trial of Telemedicine Models of Care on a Mobile Stroke Unit

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

A Randomized Trial of Telemedicine Models of Care on a Mobile Stroke Unit

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider