title: A Comparison of Remote and Bedside Assessment of the National Institute of Health Stroke Scale in Acute Stroke Patients.
abstract: Telestroke videoconference for conducting the National Institute of Health Stroke Scale (NIHSS) is recommended when the facility of a direct bedside evaluation by a stroke specialist is not immediately available for hyperacute stroke assessment. However, some NIHSS-telestroke studies inherit systematic bias due to the subjective nature of NIHSS administration. We aimed to evaluate NIHSS telestroke assessment, while implementing measures to minimize subjectivity bias.
  
  
  
  Ninety stroke patients within 48 h of onset were assessed by 6 stroke neurologists grouped in 15 pairs. Each pair of physicians assessed 6 patients. Patients were allocated through block randomization to a physician pair and order of bedside or remote assessment. Every patient was assessed once at the bedside and once remotely. Remote examination was performed by a neurologist through high-quality videoconferencing (HQ-VTC), assisted by a nurse at the patient's bedside. Kappa coefficients and the number of patients with a cumulative difference of ≤3 NIHSS points were calculated to compare bedside and remote measures.
  
  
  
  Cumulative difference of ≤3 NIHSS points was observed in 85.6% (95% CI 76.6-92.1%) cases. Therefore, every fifth remote examination may have been inaccurate. Quadratically weighted kappa for total NIHSS score was 0.91 (95% CI 0.87-0.95). Minimal agreements were for commands (k = 0.46), facial palsy (k = 0.43), and ataxia (k = 0.27). Remote assessments were longer than bedside: 8 min (interquartile range, IQR 7-9) vs. 6 (IQR 5-8), p < 0.001.
  
  
  
  NIHSS-telestroke assessment using HQ-VTC in the acute stroke settings is closely matched with NIHSS-bedside assessment but it's credibility for clinical use needs further evaluation.
authors.affiliation: Sverdlovsk Regional Clinical Hospital #1, Ekaterinburg, Russia.
authors.forename: Andrey M
authors.initials: AM
authors.lastname: Alasheev
authors.forename: Aleksey Y
authors.initials: AY
authors.lastname: Andreev
authors.forename: Yuliya V
authors.initials: YV
authors.lastname: Gonysheva
authors.forename: Maria N
authors.initials: MN
authors.lastname: Lagutenko
authors.forename: Olga Y
authors.initials: OY
authors.lastname: Lutskovich
authors.forename: Antonina V
authors.initials: AV
authors.lastname: Mamonova
authors.forename: Elena V
authors.initials: EV
authors.lastname: Prazdnichkova
authors.forename: Andrey A
authors.initials: AA
authors.lastname: Belkin
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis*; D017216:Telemedicine / Q000379:methods*; D049269:Videoconferencing
keywords: National Institute of Health Stroke Scale; Remote assessment; Stroke; Telemedicine; Telestroke