1. A low-cost, tablet-based option for prehospital neurologic assessment
- Author
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Chapman Smith, Sherita N, Govindarajan, Prasanthi, Padrick, Matthew M, Lippman, Jason M, McMurry, Timothy L, Resler, Brian L, Keenan, Kevin, Gunnell, Brian S, Mehndiratta, Prachi, Chee, Christina Y, Cahill, Elizabeth A, Dietiker, Cameron, Cattell-Gordon, David C, Smith, Wade S, Perina, Debra G, Solenski, Nina J, Worrall, Bradford B, and Southerland, Andrew M
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Neurosciences ,Brain Disorders ,Clinical Research ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Brain Ischemia ,Cell Phone ,Computers ,Handheld ,Feasibility Studies ,Humans ,Neurologists ,Pilot Projects ,Regression Analysis ,Reproducibility of Results ,Rural Population ,San Francisco ,Severity of Illness Index ,Stroke ,Telemedicine ,Transportation of Patients ,Urban Population ,Videoconferencing ,Virginia ,As the iTREAT Investigators ,Cognitive Sciences ,Neurology & Neurosurgery ,Clinical sciences - Abstract
ObjectivesIn this 2-center study, we assessed the technical feasibility and reliability of a low cost, tablet-based mobile telestroke option for ambulance transport and hypothesized that the NIH Stroke Scale (NIHSS) could be performed with similar reliability between remote and bedside examinations.MethodsWe piloted our mobile telemedicine system in 2 geographic regions, central Virginia and the San Francisco Bay Area, utilizing commercial cellular networks for videoconferencing transmission. Standardized patients portrayed scripted stroke scenarios during ambulance transport and were evaluated by independent raters comparing bedside to remote mobile telestroke assessments. We used a mixed-effects regression model to determine intraclass correlation of the NIHSS between bedside and remote examinations (95% confidence interval).ResultsWe conducted 27 ambulance runs at both sites and successfully completed the NIHSS for all prehospital assessments without prohibitive technical interruption. The mean difference between bedside (face-to-face) and remote (video) NIHSS scores was 0.25 (1.00 to -0.50). Overall, correlation of the NIHSS between bedside and mobile telestroke assessments was 0.96 (0.92-0.98). In the mixed-effects regression model, there were no statistically significant differences accounting for method of evaluation or differences between sites.ConclusionsUtilizing a low-cost, tablet-based platform and commercial cellular networks, we can reliably perform prehospital neurologic assessments in both rural and urban settings. Further research is needed to establish the reliability and validity of prehospital mobile telestroke assessment in live patients presenting with acute neurologic symptoms.
- Published
- 2016