Prehospital Utility of Rapid Stroke Evaluation Using In-Ambulance Telemedicine: A Pilot Feasibility Study
Writed by Tzu-Ching Wu, Claude Nguyen, Christy Ankrom, Julian Yang, David Persse, Farhaan Vahidy, James C Grotta, Sean I Savitz
From the Department of Neurology, University of Texas-Health Science Center at Houston (T.-C.W., C.N., C.A., F.V., J.C.G., S.I.S.); Department of Neurology, University of Texas Southwestern Medical Center, Dallas (J.Y.); and Department of Medicine (D.P.) and Department of Surgery (D.P.), Baylor College of Medicine, Houston, TX.
BACKGROUND AND PURPOSE: Prehospital evaluation using telemedicine may accelerate acute stroke treatment with tissue-type plasminogen activator. We explored the feasibility and reliability of using telemedicine in the field and ambulance to help evaluate acute stroke patients.
METHODS: Ten unique, scripted stroke scenarios, each conducted 4 times, were portrayed by trained actors retrieved and transported by Houston Fire Department emergency medical technicians to our stroke center. The vascular neurologists performed remote assessments in real time, obtaining clinical data points and National Institutes of Health (NIH) Stroke Scale, using the In-Touch RP-Xpress telemedicine device. Each scripted scenario was recorded for a subsequent evaluation by a second blinded vascular neurologist. Study feasibility was defined by the ability to conduct 80% of the sessions without major technological limitations. Reliability of video interpretation was defined by a 90% concordance between the data derived during the real-time sessions and those from the scripted scenarios.
RESULTS: In 34 of 40 (85%) scenarios, the teleconsultation was conducted without major technical complication. The absolute agreement for intraclass correlation was 0.997 (95% confidence interval, 0.992-0.999) for the NIH Stroke Scale obtained during the real-time sessions and 0.993 (95% confidence interval, 0.975-0.999) for the recorded sessions. Inter-rater agreement using κ-statistics showed that for live-raters, 10 of 15 items on the NIH Stroke Scale showed excellent agreement and 5 of 15 showed moderate agreement. Matching of real-time assessments occurred for 88% (30/34) of NIH Stroke Scale scores by ±2 points and 96% of the clinical information.
CONCLUSIONS: Mobile telemedicine is reliable and feasible in assessing actors simulating acute stroke in the prehospital setting.