Reliability of NIHSS by Telemedicine in Non-Neurologists

Berthier, Eric; Decavel, Pierre; Vuillier, Fabrice; Verlut, Clotilde; Moulin, Thierry; Medeiros, Elisabeth

doi:10.1111/j.1747-4949.2012.00965.x

Cited by 9 publications

(7 citation statements)

References 4 publications

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“…22,23 Moreover, the results are consistent even when the examination was performed by an inexperienced telemedicine examiner and between local and remote non-neurologists. 24,25 The 2013 American Stroke Association (ASA) policy statement on Interactions Within Stroke Systems of Care recommends the use of telemedicine for NIHSS assessment of patients with stroke, with the results comparable with those of inpatient assessment (class I recommendation; level of evidence A). 26 The evaluation of acute stroke brain imaging is fundamental to proceeding with stroke thrombolysis.…”

Section: Clinical Processes Of Carementioning

confidence: 99%

Effect of Telestroke on Emergent Stroke Care and Stroke Outcomes

Bladin

Cadilhac

2014

Stroke

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Section: Clinical Processes Of Carementioning

confidence: 99%

Effect of Telestroke on Emergent Stroke Care and Stroke Outcomes

Bladin

Cadilhac

2014

Stroke

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“…Though the NIHSS-telestroke examination by a neurologist using high-quality videoconferencing (HQ-VTC) is reliable [5] and recommended when the bedside assessment of such specialist is not available [6], this recommendation is based on the outcome of a few studies [7,8,9,10], which inherit systematic bias due to the subjective nature of NIHSS administration. The main sources of bias in these studies were: assessment of patients only by 2 physicians and the absence of interchange of the mode of assessment (remote or bedside) for each physician.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Remote and Bedside Assessment of the National Institute of Health Stroke Scale in Acute Stroke Patients

Алашеев¹,

Andreev²,

Gonysheva³

et al. 2017

Eur Neurol

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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 stroke patients within 48 h of onset were assessed by 6 stroke neurologists grouped in 15 pairs. Each pair of physicians assessed 6 patients. Patients were allocated through block randomization to a physician pair and order of bedside or remote assessment. Every patient was assessed once at the bedside and once remotely. Remote examination was performed by a neurologist through high-quality videoconferencing (HQ-VTC), assisted by a nurse at the patient's bedside. Kappa coefficients and the number of patients with a cumulative difference of ≤3 NIHSS points were calculated to compare bedside and remote measures. Results: Cumulative difference of ≤3 NIHSS points was observed in 85.6% (95% CI 76.6-92.1%) cases. Therefore, every fifth remote examination may have been inaccurate. Quadratically weighted kappa for total NIHSS score was 0.91 (95% CI 0.87-0.95). Minimal agreements were for commands (k = 0.46), facial palsy (k = 0.43), and ataxia (k = 0.27). Remote assessments were longer than bedside: 8 min (interquartile range, IQR 7-9) vs. 6 (IQR 5-8), p < 0.001. Conclusions: NIHSS-telestroke assessment using HQ-VTC in the acute stroke settings is closely matched with NIHSS-bedside assessment but it's credibility for clinical use needs further evaluation.

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“…The primary outcomes include hospital mortality rate and neurologic deficits as assessed by the National Institutes of Health Stroke Scale (NIHSS) 12 at time of discharge from hospital and after one month. The secondary end point was disability measured by the Modified Rankin Scale (MRS) 13 at 30-day follow-up and hemorrhagic complications during hospitalization period.…”

Section: Methodsmentioning

confidence: 99%

The efficacy and safety of low-molecular-weight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis

Afshari

Moradian

Nasiri

et al. 2015

NSJ

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Objective:To compare the efficacy and safety of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) in the treatment of patients with cerebral venous sinus thrombosis (CVST), and to provide an appropriate treatment option in these patients.Method:This is a randomized double blind clinical trial conducted between December 2013 and December 2014. The subjects were selected among patients referred to Neurology Department, Imam Reza Hospital; affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran. Fifty-two cases of CVST were included in this study and randomly divided into 2 groups. Twenty-six cases received LMWH and the other 26 cases received UFH. The primary outcomes include hospital mortality rate and neurologic deficits as assessed by the National Institutes of Health Stroke Scale (NIHSS). The secondary end point was disability as measured by the Modified Rankin Scale (MRS).Results:We observed the rate of mortality and neurological deficits and disability based on NIHSS, and the MRS did not differ between the 2 groups.Conclusion:The efficacy of LMWH and UFH in reduction of neurologic deficit and functional disability in patients with CVST are similar.

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Reliability of NIHSS by Telemedicine in Non-Neurologists

Abstract: Fig. 1 Global concordances between local and remote neurologists (top panel), and local and remote non-neurologists (bottom panel) (regression line model, validated by the Kendall coefficient).

Cited by 9 publications

References 4 publications

Effect of Telestroke on Emergent Stroke Care and Stroke Outcomes

Effect of Telestroke on Emergent Stroke Care and Stroke Outcomes

A Comparison of Remote and Bedside Assessment of the National Institute of Health Stroke Scale in Acute Stroke Patients

The efficacy and safety of low-molecular-weight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis

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