Prehospital Unassisted Assessment of Stroke Severity Using Telemedicine

Abstract

Background and Purpose-We evaluated the feasibility and the reliability of remote stroke severity quantification in the prehospital setting using the Unassisted TeleStroke Scale (UTSS) via a telestroke ambulance system and a fourthgeneration mobile network. Methods-The technical feasibility and the reliability of the UTSS were studied in healthy volunteers mimicking 41 stroke syndromes during ambulance transportation. Results-Except for 1 issue, high-quality telestroke assessment was feasible in all scenarios. The mean examination time for the UTSS was 3.1 minutes (SD, 0.4). The UTSS showed excellent intrarater and interrater variability (ρ=0.98 and 0.97; P<0.001), as well as excellent internal consistency and rater agreement. Adequate concurrent validity can be derived from the strong correlation between the UTSS and the National Institutes of Health Stroke Scale (ρ=0.90; P<0.001). Conclusions-Remote assessment of stroke severity in fast-moving ambulances using a system dedicated to prehospital telemedicine, 4G technology, and the UTSS is feasible and reliable.

Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

“…149,150 Prehospital telemedicine with 4G cellular systems is now commonplace in major cities and allows improved connectivity. In studies in Brussel using simulations in a moving ambulance 34 and then later live patients, 151 connectivity was much improved but not always reliable even with a 4G system, particularly during peak network use times. Prioritized access to bandwidth for medical services, which requires architecture that supports dedicated and guaranteed quality of service levels, is one potential solution for further improvements.…”

“…31 The new 4G technology with higher bandwidth and optional prioritization in public mobile networks appears to be more appropriate for the use of ambulance-based telestroke applications. 13,32 A streamlined unassisted telestroke scale 33 was evaluated with healthy volunteers mimicking stroke syndromes during ambulance transportation 34 and demonstrated sufficient stability in a moving ambulance using 4G connectivity. Further testing in actual acute stroke transport situations is needed to assess this promising approach.…”

In-Transit Telemedicine Speeds Ischemic Stroke Treatment

“…[5][6][7][8] Emergency medical services' (EMS) identification of likely strokes helps, 9,10 and in-ambulance teleneurology has been considered but not tested clinically. 11,12 Mobile stroke transport units (MSTUs), computed tomographic scanner-equipped ambulances with a neurologist, either in person or by telemedicine, 8 to assess thrombolytic appropriateness and oversee treatment, in the prehospital setting, decrease treatment time 25 minutes. 5,8 However, MSTUs cost US$0.75M to $1.4M 5 and require a computed tomographic technologist, an emergency medical technician, and a licensed healthcare practitioner to administer medication, incurring operating costs that can exceed US$1M/y.…”

A low-cost, tablet-based option for prehospital neurologic assessment: The iTREAT Study

“…[8][9][10] More recent studies incorporating modern cellular connectivity have shown greater reliability but involve costly telemedicine endpoints and a limited geographic scope primarily confined to urban areas. 11,12 The objective of our study, Improving Treatment with Rapid Evaluation of Acute Stroke via Mobile Telemedicine (iTREAT), is to demonstrate the reliability and technical feasibility of bidirectional, ambulance-based videoconferencing using a low cost, portable mobile telestroke system. Utilizing fourthgeneration (4G) long-term evolution (LTE) commercial broadband, we developed a tabletbased platform for emergency medical services (EMS) transport and assessed feasibility using simulated stroke scenarios.…”

“…8 More recent mobile telestroke demonstrations in Europe have shown conflicting but promising feasibility results, highlighting the importance of 4G vs 3G mobile broadband to achieve reliable continuous connectivity for uninterrupted communication. [9][10][11] In the United States, investigators in Houston, TX, reported successful feasibility and reliability of telemedicine in a mobile stroke unit using the RPXpress portable telemedicine system from InTouch Technologies, Inc. (Santa Barbara, CA). 12 Similar to our study, they utilized patient actors performing simulated stroke scenarios during ambulance transport and were able to demonstrate excellent intraclass correlation (0.997, 0.97-0.998) for the NIHSS score between real-time and scripted scenarios.…”