title: Shortening time to stroke treatment using ambulance telemedicine: TeleBAT.
abstract: OBJECTIVE
  Patients with ischemic stroke treated with tissue plasminogen activator (rt-PA) have better outcomes when treated closer to the time of symptom onset and within the 3-hour window. We previously demonstrated the clinical use of TeleBAT, a mobile telemedicine system for stroke. We tested the impact of that system on time to treatment for patients with acute stroke.
  
  
  METHODS
  Validity and reliability were tested by comparing neurologic examination scores obtained using our wireless system, which transmits video of a patient from a moving ambulance to desktop computers, with those obtained using the National Institute of Neurological Disorders and Stroke training videotape. TeleBAT validity and good interrater reliability were defined a priori as a kappa statistic of r > 0.5. We compared the average time to treatment for our TeleBAT-evaluated intervention group with that for our control group. The intervention group consisted of two actor patients with stroke mimicking 12 stroke scenarios and evaluated using TeleBAT. The control group consisted of patients with stroke evaluated and treated with rt-PA on arrival to the emergency department. Data were analyzed using standard t test.
  
  
  RESULTS
  National Institutes of Health Stroke Scale items calculated by the neurologists suggest TeleBAT is valid for assessing patients with stroke remotely. Interrater reliability was high: the neurologists gleaned the same information from TeleBAT transmissions. Kappa values for both validity and reliability exceeded 0.5. The mean time to treatment for patients assessed by TeleBAT was 17 +/- 4 minutes compared with 33 +/- 17 minutes for our control group (P = .0033).
  
  
  CONCLUSIONS
  TeleBAT seems to be a valid and reliable means of evaluating stroke neurologic deficits. Time to treatment was shortened using ambulance transport time to evaluate patients as candidates for thrombolytic therapy. Future studies should use a randomized design with patients with acute stroke.
authors: Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. mlamonte@som.umaryland.edu
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