Pooled Assessment of Computed Tomography Interpretation by Vascular Neurologists in the STRokE DOC Telestroke Network

Abstract

Background and Purpose The objective of this pooled analysis was to determine level of agreement between central read and each of two groups (spoke radiologists and hub vascular neurologists) in interpreting head computed tomography (CT) scans of stroke patients presenting to telestroke network hospitals. Methods The Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC and STRokE DOC-AZ TIME) trials were prospective, randomized, outcome-blinded trials comparing telemedicine and teleradiology to telephone-only consultations. In each trial, the subjects’ CT scans were interpreted by the hub vascular neurologist in the telemedicine arm, and by the spoke radiologist in the telephone arm. We obtained a central read for each CT using adjudicating committees blinded to treatment arm and outcome. The data were pooled and results reported for the entire population. Kappa statistics and exact agreement rates were used to assess interobserver agreement for radiographic contraindication to recombinant tissue plasminogen activator (rt-PA), presence of hemorrhage, tumor, hyperdense artery, acute stroke, prior stroke, and early ischemic changes. Results Among 261 analyzed cases, the agreement with central read for presence of radiological rt-PA contraindication was excellent for hub vascular neurologist (96.2%, κ=0.81, 95%CI 0.64–0.97), spoke radiologist report (94.7%, κ=0.64, 95%CI 0.39–0.88), and overall (95.4%, κ=0.74, 95%CI 0.59–0.88). For rt-PA treated patients (N=65), overall agreement was 98.5%, and vascular neurologist agreement with central read was 100%. Conclusions Both vascular neurologists and reports from spoke radiologists had excellent reliability in identifying radiologic rt-PA contraindications. These pooled findings demonstrate that telestroke evaluation of head CT scans for acute rt-PA assessments is reliable.

Interpretation of Brain CT Scans in the Field by Critical Care Physicians in a Mobile Stroke Unit

“…Kappa values between the anesthesiologists, radiologists, and neuroradiologists showed a good agreement. Similar results have been published when testing the level of agreement between in‐hospital stroke physicians and radiologists . Comparing classification of radiological pathology in predefined categories had fair agreement with the neuroradiologists.…”

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

“…A somewhat different methodology was used in a pooled analysis of data from Arizona and California. 87 The data were derived from prospective, randomized, outcome-blinded studies comparing telemedicine/teleradiology with telephone-only consultations. Interobserver reliability was ascertained between the hub vascular neurologist (telemedicine arm) and the spoke radiologist (telephone arm) regarding contraindications for tPA, hemorrhage, tumor, hyperdense artery, acute stroke, prior stroke, and ischemic changes.…”

Assessment of acute stroke cerebral CT examinations by anaesthesiologists

“…In the Stroke DOC Telestroke Network (2013), overall agreement on radiological contraindications for thrombolytic therapy between stroke neurologists and radiologists was tested. The study concluded that vascular neurologists are able to effectively and immediately interpret cerebral CT scans sent by teleradiology . To minimize the number of radiological misinterpretations, the anaesthesiologists should in a real life setting always consult a radiologist or a stroke neurologist using teleradiology when in doubt about the interpretation.…”