Abstract 16956: Pre-hospital Assessment of Acute Stroke Using Cellular Video-Phone
Introduction: Permanent neurologic deficit is the main cause of growing disability and health care expenditure in the US. Eligibility for timely reperfusion therapy in acute stroke is limited by early recognition, time to complete the assessment, and availability of qualified personnel.
Hypothesis: We tested the hypothesis that early pre-hospital evaluation of acute stroke patients using cellular video-phone (VP) telemedicine consultation between paramedics and physicians is accurate and can improve the time to reperfusion.
Methods: We conducted a pilot study where physicians performed in real time a remote simplified NIH stroke scale (sNIHSS) on a standardized patient using VP telemedicine with the assistance of paramedic at bedside. Later the physician performed the sNIHSS at bedside and the inter-rater agreement was assessed with kappa statistic. We removed the visual field, sensory, and extinction/neglect subscales form the original 15 NIH stroke subscales with the goal of shortening the time needed for completion, while maintaining good test performance as demonstrated by others.
Results: The study population consisted of 40 physicians. The mean sNIHSS scores using VP and bedside exam were similar (6.82 ± 1.06 vs. 6.63 ± 0.98, p=0.08). There was high inter-physician agreement (0.99, 95% CI 0.992 - 0.995). The mean time to perform the sNIHSS using VP was approximately 38 seconds longer than in the bedside examination (3.38 ± 0.8 vs. 2.93 ± 0.8 minutes, p=0.006).
Conclusions: In conclusion, the VP is a feasible, reliable, and timely tool for remotely performing the sNIHSS in patients with acute stroke. This technology promises to increase access to qualified personnel, may improve outcomes by decreasing the time to reperfusion, and may decrease costs by preventing false activation of stroke team and better resource utilization.
- © 2010 by American Heart Association, Inc.