title: Prehospital utility of rapid stroke evaluation using in-ambulance telemedicine: a pilot feasibility study.
abstract: OBJECTIVE
  Prehospital evaluation using telemedicine may accelerate acute stroke treatment with tissue-type plasminogen activator. We explored the feasibility and reliability of using telemedicine in the field and ambulance to help evaluate acute stroke patients.
  
  
  METHODS
  Ten unique, scripted stroke scenarios, each conducted 4 times, were portrayed by trained actors retrieved and transported by Houston Fire Department emergency medical technicians to our stroke center. The vascular neurologists performed remote assessments in real time, obtaining clinical data points and National Institutes of Health (NIH) Stroke Scale, using the In-Touch RP-Xpress telemedicine device. Each scripted scenario was recorded for a subsequent evaluation by a second blinded vascular neurologist. Study feasibility was defined by the ability to conduct 80% of the sessions without major technological limitations. Reliability of video interpretation was defined by a 90% concordance between the data derived during the real-time sessions and those from the scripted scenarios.
  
  
  RESULTS
  In 34 of 40 (85%) scenarios, the teleconsultation was conducted without major technical complication. The absolute agreement for intraclass correlation was 0.997 (95% confidence interval, 0.992-0.999) for the NIH Stroke Scale obtained during the real-time sessions and 0.993 (95% confidence interval, 0.975-0.999) for the recorded sessions. Inter-rater agreement using κ-statistics showed that for live-raters, 10 of 15 items on the NIH Stroke Scale showed excellent agreement and 5 of 15 showed moderate agreement. Matching of real-time assessments occurred for 88% (30/34) of NIH Stroke Scale scores by ±2 points and 96% of the clinical information.
  
  
  CONCLUSIONS
  Mobile telemedicine is reliable and feasible in assessing actors simulating acute stroke in the prehospital setting.
authors.affiliation: From the Department of Neurology, University of Texas-Health Science Center at Houston (T.-C.W., C.N., C.A., F.V., J.C.G., S.I.S.); Department of Neurology, University of Texas Southwestern Medical Center, Dallas (J.Y.); and Department of Medicine (D.P.) and Department of Surgery (D.P.), Baylor College of Medicine, Houston, TX. tzu-ching.wu@uth.tmc.edu.
authors.forename: Tzu-Ching
authors.initials: TC
authors.lastname: Wu
authors.affiliation: From the Department of Neurology, University of Texas-Health Science Center at Houston (T.-C.W., C.N., C.A., F.V., J.C.G., S.I.S.); Department of Neurology, University of Texas Southwestern Medical Center, Dallas (J.Y.); and Department of Medicine (D.P.) and Department of Surgery (D.P.), Baylor College of Medicine, Houston, TX.
authors.forename: Claude
authors.initials: C
authors.lastname: Nguyen
authors.affiliation: From the Department of Neurology, University of Texas-Health Science Center at Houston (T.-C.W., C.N., C.A., F.V., J.C.G., S.I.S.); Department of Neurology, University of Texas Southwestern Medical Center, Dallas (J.Y.); and Department of Medicine (D.P.) and Department of Surgery (D.P.), Baylor College of Medicine, Houston, TX.
authors.forename: Christy
authors.initials: C
authors.lastname: Ankrom
authors.affiliation: From the Department of Neurology, University of Texas-Health Science Center at Houston (T.-C.W., C.N., C.A., F.V., J.C.G., S.I.S.); Department of Neurology, University of Texas Southwestern Medical Center, Dallas (J.Y.); and Department of Medicine (D.P.) and Department of Surgery (D.P.), Baylor College of Medicine, Houston, TX.
authors.forename: Julian
authors.initials: J
authors.lastname: Yang
authors.affiliation: From the Department of Neurology, University of Texas-Health Science Center at Houston (T.-C.W., C.N., C.A., F.V., J.C.G., S.I.S.); Department of Neurology, University of Texas Southwestern Medical Center, Dallas (J.Y.); and Department of Medicine (D.P.) and Department of Surgery (D.P.), Baylor College of Medicine, Houston, TX.
authors.forename: David
authors.initials: D
authors.lastname: Persse
authors.affiliation: From the Department of Neurology, University of Texas-Health Science Center at Houston (T.-C.W., C.N., C.A., F.V., J.C.G., S.I.S.); Department of Neurology, University of Texas Southwestern Medical Center, Dallas (J.Y.); and Department of Medicine (D.P.) and Department of Surgery (D.P.), Baylor College of Medicine, Houston, TX.
authors.forename: Farhaan
authors.initials: F
authors.lastname: Vahidy
authors.affiliation: From the Department of Neurology, University of Texas-Health Science Center at Houston (T.-C.W., C.N., C.A., F.V., J.C.G., S.I.S.); Department of Neurology, University of Texas Southwestern Medical Center, Dallas (J.Y.); and Department of Medicine (D.P.) and Department of Surgery (D.P.), Baylor College of Medicine, Houston, TX.
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
authors.affiliation: From the Department of Neurology, University of Texas-Health Science Center at Houston (T.-C.W., C.N., C.A., F.V., J.C.G., S.I.S.); Department of Neurology, University of Texas Southwestern Medical Center, Dallas (J.Y.); and Department of Medicine (D.P.) and Department of Surgery (D.P.), Baylor College of Medicine, Houston, TX.
authors.forename: Sean I
authors.initials: SI
authors.lastname: Savitz
mesh_terms: D000368:Aged; D000552:Ambulances; D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019114:Remote Consultation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy; D017216:Telemedicine; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014481:United States
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: emergency medical services; telemedicine