Abstract:Introduction: Telestroke videoconference for conducting the National Institute of Health Stroke Scale (NIHSS) is recommended when the facility of a direct bedside evaluation by a stroke specialist is not immediately available for hyperacute stroke assessment. However, some NIHSS-telestroke studies inherit systematic bias due to the subjective nature of NIHSS administration. We aimed to evaluate NIHSS telestroke assessment, while implementing measures to minimize subjectivity bias. Patients and Methods: Ninety … Show more
“…A study found that lack of proper infrastructure or road access in rural areas may significantly lengthen OTT time, thus contributing to the low rate of thrombolysis (Alasheev et al, 2017). Telemedicine helps to address this delay by allowing neurologists from stroke centers to perform quick assessment, triage, and give emergency treatment advices to EMS dispatchers even before patients' arrival at the hospital (Jauch et al, 2013)-as shown by a reduction of roughly half an hour when compared to conventional EMS (Helwig et al, 2019).…”
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
“…A study found that lack of proper infrastructure or road access in rural areas may significantly lengthen OTT time, thus contributing to the low rate of thrombolysis (Alasheev et al, 2017). Telemedicine helps to address this delay by allowing neurologists from stroke centers to perform quick assessment, triage, and give emergency treatment advices to EMS dispatchers even before patients' arrival at the hospital (Jauch et al, 2013)-as shown by a reduction of roughly half an hour when compared to conventional EMS (Helwig et al, 2019).…”
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
“…The National Institutes of Health Stroke Scale can be performed efficiently via telemedicine. 9 Televideo is superior to telephone. 10 Yet, telephonic consultation is superior to no consult.…”
“…Meanwhile, telemedicine was also being used for other neurologic disorders such as epilepsy [2]. The main field of development for telemedicine is in acute stroke care and reliability of telestroke after remote examination of stroke patients by audio-visual connection is well established [3][4][5] by testing stroke scales. However, results of studies in telestroke service cannot be generalized into other fields of neurology [6].…”
Introduction: While there are several studies on reliability of telemedicine in assessing stroke scales, little is known about the validity of a general neurological examination performed via telemedicine. Therefore, we sought to test the agreement between bedside and remote examination in acute patients of the emergency room. Methods: Acute patients at the emergency room of a 450-bed academic teaching hospital were included in this study. A clinical neurological examination consisting of 22 items was performed at bedside and also remotely via an audio-visual link by a different neurologist; both were experienced clinicians at the consultant level. Kappa statistics were calculated for each item of the examination. Results: Forty three patients completed both examinations (mean age 58.3 years, 56% female). Patients were seen between 8 and 72 min after admission (mean 36.3 min). Total time for remote examination was 12.6 min (8–21 min) and 8.9 min (5–18 min) for bedside examination. K-coefficients ranged from 0.32 (muscle tone) – 0.82 (language) indicating a fair to excellent agreement in most items. Conclusions: Remote examination via an audio-visual link produces comparable results to bedside performance even in acute patients of the emergency room. Compared to the scarce data available, inter-observer agreement is about the same as that between 2 examiners at bedside. However, more studies on reliability and validity of clinical neurological examination are required.
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