title: Telemedicine Can Replace the Neurologist on a Mobile Stroke Unit.
abstract: The BEST-MSU study (Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit) is a comparative effectiveness trial in patients randomized to mobile stroke unit or standard management. A substudy tested interrater agreement for tissue-type plasminogen activator eligibility between a telemedicine vascular neurologist and onboard vascular neurologist.
  
  
  
  On scene, both the telemedicine vascular neurologist and onboard vascular neurologist independently evaluated the patient, documenting their tissue-type plasminogen activator treatment decision, National Institutes of Health Stroke Scale score, and computed tomographic interpretation. Agreement was determined using Cohen κ statistic. Telemedicine-related technical failures that impeded remote assessment were recorded.
  
  
  
  Simultaneous and independent telemedicine vascular neurologist and onboard vascular neurologist assessment was attempted in 174 patients. In 4 patients (2%), the telemedicine vascular neurologist could not make a decision because of technical problems. The telemedicine vascular neurologist agreed with the onboard vascular neurologist on 88% of evaluations (κ=0.73).
  
  
  
  Remote telemedicine vascular neurologist assessment is reliable and accurate, supporting either telemedicine vascular neurologist or onboard vascular neurologist assessment on our mobile stroke unit.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02190500.
authors.affiliation: From the Department of Neurology (T.-C.W., S.A.P., A.J., R.B.) and Department of Biostatistics, School of Public Health (J.-M.Y.), University of Texas Health Science Center at Houston; Department of Neurology, Houston Methodist Neurological Institute (A.T.); University of Vermont College of Medicine (A.Y.); and Memorial Hermann Hospital (J.C.G.). tzu-ching.wu@uth.tmc.edu.
authors.forename: Tzu-Ching
authors.initials: TC
authors.lastname: Wu
authors.affiliation: From the Department of Neurology (T.-C.W., S.A.P., A.J., R.B.) and Department of Biostatistics, School of Public Health (J.-M.Y.), University of Texas Health Science Center at Houston; Department of Neurology, Houston Methodist Neurological Institute (A.T.); University of Vermont College of Medicine (A.Y.); and Memorial Hermann Hospital (J.C.G.).
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Parker
authors.affiliation: From the Department of Neurology (T.-C.W., S.A.P., A.J., R.B.) and Department of Biostatistics, School of Public Health (J.-M.Y.), University of Texas Health Science Center at Houston; Department of Neurology, Houston Methodist Neurological Institute (A.T.); University of Vermont College of Medicine (A.Y.); and Memorial Hermann Hospital (J.C.G.).
authors.forename: Amanda
authors.initials: A
authors.lastname: Jagolino
authors.affiliation: From the Department of Neurology (T.-C.W., S.A.P., A.J., R.B.) and Department of Biostatistics, School of Public Health (J.-M.Y.), University of Texas Health Science Center at Houston; Department of Neurology, Houston Methodist Neurological Institute (A.T.); University of Vermont College of Medicine (A.Y.); and Memorial Hermann Hospital (J.C.G.).
authors.forename: Jose-Miguel
authors.initials: JM
authors.lastname: Yamal
authors.affiliation: From the Department of Neurology (T.-C.W., S.A.P., A.J., R.B.) and Department of Biostatistics, School of Public Health (J.-M.Y.), University of Texas Health Science Center at Houston; Department of Neurology, Houston Methodist Neurological Institute (A.T.); University of Vermont College of Medicine (A.Y.); and Memorial Hermann Hospital (J.C.G.).
authors.forename: Ritvij
authors.initials: R
authors.lastname: Bowry
authors.affiliation: From the Department of Neurology (T.-C.W., S.A.P., A.J., R.B.) and Department of Biostatistics, School of Public Health (J.-M.Y.), University of Texas Health Science Center at Houston; Department of Neurology, Houston Methodist Neurological Institute (A.T.); University of Vermont College of Medicine (A.Y.); and Memorial Hermann Hospital (J.C.G.).
authors.forename: Abraham
authors.initials: A
authors.lastname: Thomas
authors.affiliation: From the Department of Neurology (T.-C.W., S.A.P., A.J., R.B.) and Department of Biostatistics, School of Public Health (J.-M.Y.), University of Texas Health Science Center at Houston; Department of Neurology, Houston Methodist Neurological Institute (A.T.); University of Vermont College of Medicine (A.Y.); and Memorial Hermann Hospital (J.C.G.).
authors.forename: Amy
authors.initials: A
authors.lastname: Yu
authors.affiliation: From the Department of Neurology (T.-C.W., S.A.P., A.J., R.B.) and Department of Biostatistics, School of Public Health (J.-M.Y.), University of Texas Health Science Center at Houston; Department of Neurology, Houston Methodist Neurological Institute (A.T.); University of Vermont College of Medicine (A.Y.); and Memorial Hermann Hospital (J.C.G.).
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units / Q000639:trends; D000072141:Neurologists / Q000639:trends; D010865:Pilot Projects; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D017216:Telemedicine / Q000379:methods* / Q000639:trends; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed
chemical_list: D010959:Tissue Plasminogen Activator
keywords: ambulance; emergency medical services; stroke; telemedicine; tissue-type plasminogen activator