Telestroke ambulances in prehospital stroke management: concept and pilot feasibility study.
OBJECTIVE
Pre- and intrahospital time delays are major concerns in acute stroke care. Telemedicine-equipped ambulances may improve time management and identify patients with stroke eligible for thrombolysis by an early prehospital stroke diagnosis. The aims of this study were (1) to develop a telestroke ambulance prototype; (2) to test the reliability of stroke severity assessment; and (3) to evaluate its feasibility in the prehospital emergency setting.


METHODS
Mobil, real-time audio-video streaming telemedicine devices were implemented into advanced life support ambulances. Feasibility of telestroke ambulances and reliability of the National Institutes of Health Stroke Scale assessment were tested using current wireless cellular communication technology (third generation) in a prehospital stroke scenario. Two stroke actors were trained in simulation of differing right and left middle cerebral artery stroke syndromes. National Institutes of Health Stroke Scale assessment was performed by a hospital-based stroke physician by telemedicine, by an emergency physician guided by telemedicine, and "a posteriori" on the basis of video documentation.


RESULTS
In 18 of 30 scenarios, National Institutes of Health Stroke Scale assessment could not be performed due to absence or loss of audio-video signal. In the remaining 12 completed scenarios, interrater agreement of National Institutes of Health Stroke Scale examination between ambulance and hospital and ambulance and "a posteriori" video evaluation was moderate to good with weighted κ values of 0.69 (95% CI, 0.51-0.87) and 0.79 (95% CI, 0.59-0.98), respectively.


CONCLUSIONS
Prehospital telestroke examination was not at an acceptable level for clinical use, at least on the basis of the used technology. Further technical development is needed before telestroke is applicable for prehospital stroke management during patient transport.
Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany. thomas.liman@charite.de
Thomas G
TG
Liman
Benjamin
B
Winter
Carolin
C
Waldschmidt
Norman
N
Zerbe
Peter
P
Hufnagl
Heinrich J
HJ
Audebert
Matthias
M
Endres
D000552:Ambulances; D001604:Berlin; D040421:Cell Phone; D003199:Computer Systems; D004632:Emergency Medical Services / Q000458:organization & administration*; D005240:Feasibility Studies; D006801:Humans; D015588:Observer Variation; D016544:Patient Simulation; D010820:Physicians; D010865:Pilot Projects; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D017216:Telemedicine / Q000458:organization & administration*; D015912:Thrombolytic Therapy