title: Prehospital unassisted assessment of stroke severity using telemedicine: a feasibility study.
abstract: OBJECTIVE
  We evaluated the feasibility and the reliability of remote stroke severity quantification in the prehospital setting using the Unassisted TeleStroke Scale (UTSS) via a telestroke ambulance system and a fourth-generation mobile network.
  
  
  METHODS
  The technical feasibility and the reliability of the UTSS were studied in healthy volunteers mimicking 41 stroke syndromes during ambulance transportation.
  
  
  RESULTS
  Except for 1 issue, high-quality telestroke assessment was feasible in all scenarios. The mean examination time for the UTSS was 3.1 minutes (SD, 0.4). The UTSS showed excellent intrarater and interrater variability (ρ=0.98 and 0.97; P<0.001), as well as excellent internal consistency and rater agreement. Adequate concurrent validity can be derived from the strong correlation between the UTSS and the National Institutes of Health Stroke Scale (ρ=0.90; P<0.001).
  
  
  CONCLUSIONS
  Remote assessment of stroke severity in fast-moving ambulances using a system dedicated to prehospital telemedicine, 4G technology, and the UTSS is feasible and reliable.
authors.affiliation: From the Department of Neurology (R.-J.V.H., M.C., R.V.D., A.D.S., J.D.K., R.B.), Department of Neurosurgery (M.M.), and Department of Emergency Medicine (I.H.), Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences (R.-J.V.H., M.C., A.D.S., M.M., A.V.E., A.C., J.D.K., R.B.), and Research Group on Emergency and Disaster Medicine Brussels (I.H.), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Flanders District of Creativity, Leuven, Belgium (R.V.d.C.); and Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (J.D.K.).
authors.forename: Robbert-Jan
authors.initials: RJ
authors.lastname: Van Hooff
authors.forename: Melissa
authors.initials: M
authors.lastname: Cambron
authors.forename: Rita
authors.initials: R
authors.lastname: Van Dyck
authors.forename: Ann
authors.initials: A
authors.lastname: De Smedt
authors.forename: Maarten
authors.initials: M
authors.lastname: Moens
authors.forename: Alexis Valenzuela
authors.initials: AV
authors.lastname: Espinoza
authors.forename: Rohny
authors.initials: R
authors.lastname: Van de Casseye
authors.forename: Andre
authors.initials: A
authors.lastname: Convents
authors.forename: Ives
authors.initials: I
authors.lastname: Hubloue
authors.forename: Jacques
authors.initials: J
authors.lastname: De Keyser
authors.forename: Raf
authors.initials: R
authors.lastname: Brouns
mesh_terms: D000328:Adult; D000552:Ambulances / Q000592:standards; D006801:Humans; D020407:Internet / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012984:Software; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology*; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods
keywords: acute; diagnostic methods; stroke; stroke management; telemedicine