Remote assessment of stroke using the iPhone 4.
Therapy with recombinant tissue plasminogen activator is underused in the treatment of ischemic stroke in rural hospitals, due to a lack of local stroke expertise. Telemedicine solutions for stroke are a level I, class A recommendation when a vascular neurologist is absent. However, current solutions require exorbitant startup costs, which are prohibitive for the rural hospitals in which they are needed most. This study demonstrates the efficacy of using the relatively inexpensive iPhone 4 in telestroke management. Twenty patients with stroke were assessed at the bedside using an iPhone 4, and each examination was directed remotely on another iPhone 4. Both the physician performing the bedside exam and the remote physician calculated a National Institutes of Health Stroke Scale (NIHSS) score for each patient. Each physician was blinded to the other's NIHSS score. In the 20 patients assessed, NIHSS scores ranged from 0 to 22. Interrater reliability assessed using the κ statistic demonstrated excellent agreement in 10 items (level of consciousness, month and age, visual fields, right motor arm, left motor arm, right motor leg, left motor leg, sensation, language, and neglect), moderate agreement in 3 items (gaze, facial palsy, and dysarthria), and poor agreement in 1 item (ataxia). Total NIHSS scores obtained remotely and at bedside showed an excellent level of agreement (intraclass correlation coefficient, 0.98). Our findings indicate that the iPhone 4 is an economical mobile solution that can be used to assess stroke patients remotely with high fidelity and can be readily incorporated into a telestroke network.
Department of Neurology, Emory University, Atlanta, Georgia 30033, USA. eric.anderson@emory.edu
Eric R
ER
Anderson
Bryan
B
Smith
Moges
M
Ido
Michael
M
Frankel
D000328:Adult; D000368:Aged; D040421:Cell Phone / Q000191:economics; D034201:Computers, Handheld / Q000191:economics; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D019095:Point-of-Care Systems / Q000191:economics; D011237:Predictive Value of Tests; D011379:Prognosis; D019114:Remote Consultation / Q000191:economics / Q000295:instrumentation*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D013997:Time Factors