Telemedicine in Emergency Evaluation of Acute Stroke

Abstract

Background and Purpose-In acute stroke care, rapid but careful evaluation of patients is mandatory but requires an experienced stroke neurologist. Telemedicine offers the possibility of bringing such expertise quickly to more patients. This study tested for the first time whether remote video examination is feasible and reliable when applied in emergency stroke care using the National Institutes of Health Stroke Scale (NIHSS). Methods-We used a novel multimedia telesupport system for transfer of real-time video sequences and audio data. The remote examiner could direct the set-top camera and zoom from distant overviews to close-ups from the personal computer in his office. Acute stroke patients admitted to our stroke unit were examined on admission in the emergency room. Standardized examination was performed by use of the NIHSS (German version) via telemedicine and compared with bedside application. Results-In this pilot study, 41 patients were examined. Total examination time was 11.4 minutes on average (range, 8 to 18 minutes). None of the examinations had to be stopped or interrupted for technical reasons, although minor problems (brightness, audio quality) with influence on the examination process occurred in 2 sessions. Unweighted coefficients ranged from 0.44 to 0.89; weighted coefficients, from 0.85 to 0.99. Conclusions-Remote examination of acute stroke patients with a computer-based telesupport system is feasible and reliable when applied in the emergency room; interrater agreement was good to excellent in all items. For more widespread use, some problems that emerge from details like brightness, optimal camera position, and audio quality should be solved.

Telestroke Ambulances in Prehospital Stroke Management

“…14,15 The weighted value is qualified as follows: Ͻ0.40 defines poor agreement, between 0.40 and 0.75 defines moderate, and Ͼ0.75 defines good agreement. SAS software (SAS 9.2; SAS Institute Inc, Cary, NC) was used for all analyses.…”

Effect of Telestroke on Emergent Stroke Care and Stroke Outcomes

“…Importantly, this can be done by telemedicine, with little additional time delay and with an inter-rater reliability, showing a strong correlation between NIHSS performed at the bedside and at a remote location (r=0.9552). [20][21][22] The NIHSS clinical assessment is robust across different locations and technologies, including desktop computer, laptop, and even a prehospital clinical assessment using video cell phone. 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.…”

“…[20][21][22] The NIHSS clinical assessment is robust across different locations and technologies, including desktop computer, laptop, and even a prehospital clinical assessment using video cell phone. 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).…”

Neurofluctuation in patients with subcortical ischemic stroke

“…Similar agreement statistics for m-NIHSS have been reported by other centers. [26][27][28][29][30] Finally, although we defined ND as a greater than 1-point change, 27 of the 37 patients (73%) who deteriorated had a greater than 1-point increase on the m-NIHSS.…”