Prehospital Teleconsultation and Imaging-Guided Destination Choice: A Systematic Review

Abstract

Background:
Prehospital destination decisions determine timely access to definitive imaging and reperfusion pathways for acute stroke, myocardial infarction, and other emergencies. Teleconsultation with prehospital diagnostic transmission may reduce uncertainty and enable direct routing to capable centers.
Methods:
PubMed was searched for English-language human studies evaluating prehospital teleconsultation plus diagnostic transmission (computed tomography–enabled stroke models, point-of-care imaging, or electrocardiogram transmission) that influenced hospital destination choice or pathway activation. Clinical trials and cohort studies were included, data were extracted in duplicate, and results were synthesized narratively without meta-analysis.
Results:
Eleven studies were included. In stroke, a mobile computed tomography pathway reduced call-to-therapy-decision time by 41 minutes (35 vs 76 minutes; 95% confidence interval 36–48) and ambulance-based thrombolysis reduced alarm-to-thrombolysis time by 25 minutes (interquartile range 13–34); onset-to-thrombolysis time was 72 vs 108 minutes in a multi-center controlled study. Disability outcomes favored mobile imaging dispatch in large cohorts (common odds ratio for worse disability 0.71; 95% confidence interval 0.58–0.86), and in ST-segment elevation myocardial infarction, telecardiology-supported electrocardiogram transmission increased direct catheterization-laboratory routing to 69.8% and reduced system delay (76 vs 90 minutes) and door-to-balloon time (57.78 vs 141.70 minutes).
Conclusions:
Teleconsultation paired with actionable diagnostic transmission shortened key system delays and improved destination-pathway alignment, with the most reproducible benefits in imaging-enabled stroke and telecardiology-supported myocardial infarction networks.