Prehospital Utility of Rapid Stroke Evaluation Using In-Ambulance Telemedicine: A Pilot Feasibility Study

• Published in: Stroke (1970) Vol. 45; no. 8; pp. 2342 - 2347
• Main Authors: Wu, Tzu-Ching, Nguyen, Claude, Ankrom, Christy, Yang, Julian, Persse, David, Vahidy, Farhaan, Grotta, James C, Savitz, Sean I
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01-08-2014; Lippincott Williams & Wilkins
• Subjects: Aged; Ambulances; Biological and medical sciences; Brain Ischemia - diagnosis; Brain Ischemia - drug therapy; Feasibility Studies; Female; Fibrinolytic Agents - therapeutic use; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Pilot Projects; Remote Consultation; Reproducibility of Results; Severity of Illness Index; Stroke - diagnosis; Stroke - drug therapy; Telemedicine; Time Factors; Tissue Plasminogen Activator - therapeutic use; United States; Vascular diseases and vascular malformations of the nervous system; United States; Vascular disease; emergency medical services; Stroke; Nervous system diseases; Telemedicine; Central nervous system disease; Cardiovascular disease; Emergency; Cerebrovascular disease; Cerebral disorder; telemedicine
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.114.005193

BACKGROUND AND PURPOSE—Prehospital evaluation using telemedicine may accelerate acute stroke treatment with tissue-type plasminogen activator. We explored the feasibility and reliability of using telemedicine in the field and ambulance to help evaluate acute stroke patients.
METHODS—Ten unique, scripted stroke scenarios, each conducted 4 times, were portrayed by trained actors retrieved and transported by Houston Fire Department emergency medical technicians to our stroke center. The vascular neurologists performed remote assessments in real time, obtaining clinical data points and National Institutes of Health (NIH) Stroke Scale, using the In-Touch RP-Xpress telemedicine device. Each scripted scenario was recorded for a subsequent evaluation by a second blinded vascular neurologist. Study feasibility was defined by the ability to conduct 80% of the sessions without major technological limitations. Reliability of video interpretation was defined by a 90% concordance between the data derived during the real-time sessions and those from the scripted scenarios.
RESULTS—In 34 of 40 (85%) scenarios, the teleconsultation was conducted without major technical complication. The absolute agreement for intraclass correlation was 0.997 (95% confidence interval, 0.992–0.999) for the NIH Stroke Scale obtained during the real-time sessions and 0.993 (95% confidence interval, 0.975–0.999) for the recorded sessions. Inter-rater agreement using κ-statistics showed that for live-raters, 10 of 15 items on the NIH Stroke Scale showed excellent agreement and 5 of 15 showed moderate agreement. Matching of real-time assessments occurred for 88% (30/34) of NIH Stroke Scale scores by ±2 points and 96% of the clinical information.
CONCLUSIONS—Mobile telemedicine is reliable and feasible in assessing actors simulating acute stroke in the prehospital setting.