Abstract 90: NIH Stroke Scale Assessment via iPad-based Mobile Telestroke During Ambulance Transport is Feasible - Pilot data from the Improving Treatment with Rapid Evaluation of Acute Stroke via Mobile Telemedecine (iTREAT) Study

Abstract

Introduction: The AHA-ASA Target:Stroke Program calls for innovative approaches to prehospital stroke care. We previously showed that mobile videoconferencing during ambulance transport is technically feasible in a rural EMS setting using an iPad-based telemedicine system. We now hypothesize that this mobile telestroke system is clinically feasible as measured by agreement of the NIH Stroke Scale (NIHSS) between face-to-face (FTF) and remote ambulance-based assessments (iTREAT). Methods: The iTREAT system comprises an Apple iPad® with retina display, high-speed 4G LTE modem, Cisco Jabber secure video conferencing application, mounting apparatus, and magnetic external antenna. We developed 4 unique stroke and 2 unique stroke-mimic scenarios to simulate prehospital stroke alerts. We recruited 3 standardized patients each assigned two scenarios, and randomly assigned each scenario to one of 6 major ambulance routes triaging to UVA Medical Center. To eliminate bias, we alternated the order of FTF and iTREAT evaluations. Statistical measures were inter- and intra-rater correlation coefficient for the NIHSS and audio/visual(AV) quality ratings on a 6-point scale (>4 indicating “good” or “excellent” connectivity). Results: For the 12 iTREAT and 10 FTF evaluations (two FTF missing data), intra-rater correlation of NIHSS scores was consistently >0.91 (mean=0.96). Inter-rater correlation for FTF evaluations was >0.89 (mean 0.96), and inter-rater correlation for iTREAT evaluations was >0.84 (mean=0.94). AV quality ratings during all iTREAT evaluations were deemed “good” or “excellent” (audio mean=5.3, median=5.5; video mean=4.67, median=4.5). Both NIHSS correlation and AV quality rating increased over the study period. Conclusion: In this pilot feasibility study, NIHSS scores obtained via ambulance using our iPad-based mobile telestroke system correlated well with in person assessments. These results support further research to determine feasibility and efficacy of this low-cost mobile telestroke system in prehospital stroke care.