title: CT interpretation in a telestroke network: agreement among a spoke radiologist, hub vascular neurologist, and hub neuroradiologist.
abstract: OBJECTIVE
  The American Stroke Association guidelines emphasized the need for further high-quality studies that assess agreement by radiologists and nonradiologists engaged in emergency telestroke assessments and decision-making. Therefore, the objective of this study was to determine the level of agreement of baseline brain CT scan interpretations of patients with acute stroke presenting to telestroke spoke hospitals between central reading committee neuroradiologists and each of 2 groups, spoke hospital radiologists and hub hospital vascular neurologists (telestrokologists).
  
  
  METHODS
  The Stroke Team Remote Evaluation Using a Digital Observation Camera Arizona trial was a prospective, urban single-hub, rural 2-spoke, randomized, blinded, controlled trial of a 2-way, site-independent, audiovisual telemedicine and teleradiology system designed for remote evaluation of adult patients with acute stroke versus telephone consultation to assess eligibility for treatment with intravenous thrombolysis. In the telemedicine arm, the subjects' CT scans were interpreted by the hub telestrokologist and in the telephone arm by the spoke radiologist. All subjects' CT scans were subsequently interpreted centrally, independently, and blindly by 2 hub neuroradiologists. The primary CT outcome was determination of a CT-based contraindication to thrombolytic treatment. Kappa statistics and exact agreement rates were used to analyze interobserver agreement.
  
  
  RESULTS
  Fifty-four subjects underwent random assignment. The overall agreement for the presence of radiological contraindications to thrombolysis was excellent (0.91) and did not differ substantially between the hub telestrokologist to neuroradiologist and spoke radiologist to neuroradiologist (0.92 and 0.89, respectively).
  
  
  CONCLUSIONS
  In the context of a telestroke network designed to assess patients with acute stroke syndromes, agreement over the presence or absence of radiological contraindications to thrombolysis was excellent whether the comparisons were between a telestrokologist and neuroradiologist or between spoke radiologist and neuroradiologist.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00623350.
authors.affiliation: Department of Neurology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA. demaerschalk.bart@mayo.edu
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
authors.forename: Bentley J
authors.initials: BJ
authors.lastname: Bobrow
authors.forename: Rema
authors.initials: R
authors.lastname: Raman
authors.forename: Karin
authors.initials: K
authors.lastname: Ernstrom
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Hoxworth
authors.forename: Ameet C
authors.initials: AC
authors.lastname: Patel
authors.forename: Terri-Ellen J
authors.initials: TE
authors.lastname: Kiernan
authors.forename: Maria I
authors.initials: MI
authors.lastname: Aguilar
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Ingall
authors.forename: David W
authors.initials: DW
authors.lastname: Dodick
authors.forename: Brett C
authors.initials: BC
authors.lastname: Meyer
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D002309:Cardiology / Q000379:methods / Q000592:standards; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D009462:Neurology / Q000379:methods / Q000592:standards; D015588:Observer Variation; D011871:Radiology / Q000379:methods / Q000592:standards; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D019112:Teleradiology / Q000379:methods / Q000592:standards*; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents