title: Reliability of real-time video smartphone for assessing National Institutes of Health Stroke Scale scores in acute stroke patients.
abstract: OBJECTIVE
  Telestroke reduces acute stroke care disparities between urban stroke centers and rural hospitals. Current technologies used to conduct remote patient assessments have high start-up costs, yet they cannot consistently establish quality timely connections. Smartphones can be used for high-quality video teleconferencing. They are inexpensive and ubiquitous among health care providers. We aimed to study the reliability of high-quality video teleconferencing using smartphones for conducting the National Institutes of Health Stroke Scale (NIHSS).
  
  
  METHODS
  Two vascular neurologists assessed 100 stroke patients with the NIHSS. The remote vascular neurologist assessed subjects using smartphone videoconferencing with the assistance of a bedside medical aide. The bedside vascular neurologist scored patients contemporaneously. Each vascular neurologist was blinded to the other's NIHSS scores. We tested the inter-method agreement and physician satisfaction with the device.
  
  
  RESULTS
  We demonstrated high total NIHSS score correlation between the methods (r=0.949; P<0.001). The mean total NIHSS scores for bedside and remote assessments were 7.93±8.10 and 7.28±7.85, with ranges, of 0 to 35 and 0 to 37, respectively. Eight categories had high agreement: level of consciousness (questions), level of consciousness (commands), visual fields, motor left and right (arm and leg), and best language. Six categories had moderate agreement: level of consciousness (consciousness), best gaze, facial palsy, sensory, dysarthria, and extinction/inattention. Ataxia had poor agreement. There was high physician satisfaction with the smartphone.
  
  
  CONCLUSIONS
  Smartphone high-quality video teleconferencing is reliable, easy to use, affordable for telestroke NIHSS administration, and has high physician satisfaction.
authors.affiliation: Department of Neurology, Mayo Clinic, University of Arizona College of Medicine, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA. demaerschalk.bart@mayo.edu
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
authors.forename: Sravanthi
authors.initials: S
authors.lastname: Vegunta
authors.forename: Bert B
authors.initials: BB
authors.lastname: Vargas
authors.forename: Qing
authors.initials: Q
authors.lastname: Wu
authors.forename: Dwight D
authors.initials: DD
authors.lastname: Channer
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Hentz
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D040421:Cell Phone / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D009462:Neurology / Q000592:standards* / Q000706:statistics & numerical data; D015588:Observer Variation; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D020521:Stroke / Q000175:diagnosis*; D017216:Telemedicine / Q000295:instrumentation / Q000592:standards*; D014481:United States; D049269:Videoconferencing / Q000295:instrumentation / Q000592:standards*