University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Internal medicine/academia


Dr. Laura Witte



Objective: The purpose of this article is to compare stroke outcomes in rural versus urban settings and to identify potential ways to improve morbidity, mortality, debility, and overall cost burden by bridging the gaps to standard of care.

Methods: A literature search was completed on Pubmed and Google Scholar to identify relevant articles for this clinical review. The following search terms were utilized when searching Pubmed/Google Scholar: cerebrovascular accident, ischemic stroke outcomes, rural, rural population(s), rural health, urban population, urban health, standard of care, screening/diagnostic, stroke risk factors, stroke therapies, telemedicine, and telestroke. The initial advisory committee was composed of one PA faculty member and the Health Sciences librarian. A third PA faculty member was added for perspective and prior experience purposes.

Results: Eighteen pertinent articles were retrieved and served as the basis for this clinical review. Overall long term functional outcomes in ischemic stroke are improved with thrombolysis regardless of geographic location.1 However, patients in urban settings are more likely than their rural counterparts to receive thrombolysis.2 The main limiting factor for timely evaluation and treatment of patients with ischemic stroke in rural areas is access to facilities equipped with the capabilities needed to treat the condition adequately which includes access to providers with advanced stroke management training. Telemedicine or telestroke is a way for rural areas to have real-time access to the clinical expertise required to promote improved outcomes in stroke care. Despite the demonstrated widespread need for telestroke in rural areas to improve outcomes in stroke care, its use remains limited.

Conclusions: Rural areas would benefit the most from access to telestroke, but there continues to be a significant disparity in the availability of these services for those that are most in need. Large-scale implementation of telestroke capabilities in rural hospital settings is likely to improve stroke outcomes overall.

Keywords: cerebrovascular accident, rural population, standard of care, telemedicine, telestroke


1. Sandercock PAG, Ricci S. Controversies in Thrombolysis. Curr Neurol Neurosci Rep. 2017;17(8):60. doi:10.1007/s11910-017-0767-5

2. Dwyer M, Rehman S, Ottavi T, et al. Urban-rural differences in the care and outcomes of acute stroke patients: Systematic review. J Neurol Sci. 2019;397:63-74. doi:10.1016/j.jns.2018.12.021


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