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Chapman Smith SN, Govindarajan P, Padrick MM, Lippman JM, McMurry TL, Resler BL, Keenan K, Gunnell BS, Mehndiratta P, Chee CY, Cahill EA, Dietiker C, Cattell-Gordon DC, Smith WS, Perina DG, Solenski NJ, Worrall BB, Southerland AM. A low-cost, tablet-based option for prehospital neurologic assessment: The iTREAT Study. Neurology 2016; 87:19-26. [PMID: 27281534 DOI: 10.1212/wnl.0000000000002799] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/08/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In this 2-center study, we assessed the technical feasibility and reliability of a low cost, tablet-based mobile telestroke option for ambulance transport and hypothesized that the NIH Stroke Scale (NIHSS) could be performed with similar reliability between remote and bedside examinations. METHODS We piloted our mobile telemedicine system in 2 geographic regions, central Virginia and the San Francisco Bay Area, utilizing commercial cellular networks for videoconferencing transmission. Standardized patients portrayed scripted stroke scenarios during ambulance transport and were evaluated by independent raters comparing bedside to remote mobile telestroke assessments. We used a mixed-effects regression model to determine intraclass correlation of the NIHSS between bedside and remote examinations (95% confidence interval). RESULTS We conducted 27 ambulance runs at both sites and successfully completed the NIHSS for all prehospital assessments without prohibitive technical interruption. The mean difference between bedside (face-to-face) and remote (video) NIHSS scores was 0.25 (1.00 to -0.50). Overall, correlation of the NIHSS between bedside and mobile telestroke assessments was 0.96 (0.92-0.98). In the mixed-effects regression model, there were no statistically significant differences accounting for method of evaluation or differences between sites. CONCLUSIONS Utilizing a low-cost, tablet-based platform and commercial cellular networks, we can reliably perform prehospital neurologic assessments in both rural and urban settings. Further research is needed to establish the reliability and validity of prehospital mobile telestroke assessment in live patients presenting with acute neurologic symptoms.
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Affiliation(s)
- Sherita N Chapman Smith
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Prasanthi Govindarajan
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Matthew M Padrick
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Jason M Lippman
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Timothy L McMurry
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Brian L Resler
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Kevin Keenan
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Brian S Gunnell
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Prachi Mehndiratta
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Christina Y Chee
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Elizabeth A Cahill
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Cameron Dietiker
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - David C Cattell-Gordon
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Wade S Smith
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Debra G Perina
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Nina J Solenski
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Bradford B Worrall
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current)
| | - Andrew M Southerland
- From the Departments of Neurology (S.N.C.S., M.M.P., J.M.L., P.M., C.Y.C., N.J.S., B.B.W., A.M.S.), Public Health Sciences (T.L.M., B.B.W., A.M.S.), and Emergency Medicine (D.G.P.), and Center for Telehealth (B.S.G., D.C.C.-G.), University of Virginia Health System, Charlottesville; Department of Neurology (S.N.C.S., P.M.), Virginia Commonwealth University Health System, Richmond, VA (current); Departments of Emergency Medicine (P.G., B.L.R.) and Neurology (K.K., E.A.C., C.D., W.S.S.), University of California, San Francisco Medical Center; and Department of Emergency Medicine (P.G.), Stanford University Medical Center, Palo Alto, CA (current).
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