Prospective reliability of the STRokE DOC Wireless/Site Independent Telemedicine System
Abstract
The authors evaluated a site-independent telemedicine system. Telemedicine may be limited by the need for fixed connectivity. Wireless and site-independent technologies eliminate this limitation. Twenty-five stroke patients underwent evaluations by remote and bedside examiners. Ten of 15 (67%) NIH Stroke Scale and 9 of 11 (82%) Modified NIH Stroke Scale items showed excellent interrater reliability. Spearman correlations were ≥0.93. This Internet system is reliable and valid. Further studies should assess its use in acute stroke.
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References
1.
Alberts MJ, Hademenos G, Latchaw RE, et al. Recommendations for the establishment of primary stroke centers. Brain Attack Coalition. JAMA 2000;283:3102–3109.
2.
Roine R, Ohinmaa A, Hailey D. Assessing telemedicine: a systematic review of the literature. CMAJ 2001;165:765–771.
3.
Levine SR, Gorman M. “Telestroke” The application of telemedicine for stroke. Stroke 1999;30:464–469.
4.
Goldstein LB, Bartels C, Davis JN. Interrater reliability of the NIH Stroke Scale. Arch Neurol 1989;46:660–662.
5.
Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864–870.
6.
Meyer BC, Hemmen TM, Jackson CM, Lyden PD. Modified National Institutes of Health Stroke Scale for use in stroke clinical trials. Stroke 2002;33:1261–1266.
7.
Shafqat S, Kvedar JC, Guanci MM, Chang Y, Schwamm LH. Role for telemedicine in acute stroke: feasibility and reliability of remote administration of the NIH Stroke Scale. Stroke 1999;30:2141–2145.
8.
LaMonte MP, Bahouth MN, Hu P, et al. Telemedicine for acute stroke: triumphs and pitfalls. Stroke 2003;34:725–728.
9.
Mahoney FT, Barthel DW. Functional evaluation: Barthel Index. Md State Med J 1965;14:61–65.
10.
Rankin J. Cerebral vascular accidents in patients over the age of 60: prognosis. Scott Med J 1957;2:200–215.
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Published online: March 21, 2005
Published in print: March 22, 2005
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The San Diego wireless telemedicine stroke evaluation arrangement described by Meyer et al is unusual. [1] Our similar REACH (Remote Evaluation of Acute isCHemic stroke) system at the Medical College of Georgia (MCG) uses secure Internet connections to evaluate acute stroke patients in rural hospitals of north central Georgia in the Nation's "stroke belt."
Like the San Diego system, REACH uses any broadband (DSL or cable modem) Internet accessible computer, nationwide. However, without a broadband wireless bubble over Augusta, Georgia, consulting physicians still need access to a fixed desktop or wireless Internet connection.
Our validation of the remote reliability in 2002 of the NIH stroke score via the REACH system also showed no greater than three points difference between bedside and remote evaluators. [2] REACH has currently expanded live 24/7/365 coverage to eight rural hospitals within a 90-mile radius of Augusta. The rural sites with broadband Internet access have a wireless router, mobile wireless cart with a PC, a remotely driven camera, and battery backup installed in the Emergency Department (ED). The rural hospitals have 24/7 CT scan capability with DICOM compatibility, as our system also integrates sending a one way video stream and the patient's CT scan which the REACH consultant interprets. A validating standard verifies that the CT scan can be reliably read from any desktop. Technical specifications of the system have been reported. [2-4]
In the three-year expansion of REACH more than 200 consultations have been performed with 31 patients receiving tPA, of which 18 received thrombolysis in under 2 hours. To date, there have been no hemorrhagic complications. Despite sporadic technical problems it has been possible to complete every consult.
We concur that provision of neurology expertise via a live Internet consultation can greatly improve acute stroke care. Given connectivity to a certified stroke center, the smallest rural hospitals would effectively meet BAC criteria as stroke centers. [5] Hub and Spoke Networks would exponentially speed the realization of a nationwide net of primary and comprehensive stroke centers such that no stroke patient is beyond reach.
Unfortunately, barriers include slow-to-change reimbursement policies, state licensing, and individual hospital privileging policies which lag behind. With these types of networked rural sites, it will become easier to implement safer treatment modalities and facilitate early treatment of patients with hemorrhagic strokes, once effective agents are approved.
References
1. Meyer BC, Lyden PD, Al-Khoury L et al. Prospective Reliability of the STRokE DOC Wireless/Site Independent Telemedicine System. Neurology 2005; 64: 1058-1060.
2. Wang S, Lee SB, Pardue C, et al. Remote Evaluation of Acute Ischemic Stroke - Reliability of National Institutes of Health Stroke Scale via Telestroke. Stroke 2003; 23: e188-e191.
3. Wang S, Gross H, Lee SB, et al. Remote Evaluation of Acute Ischemic Stroke in Rural Community Hospitals in Georgia. Stroke 2004;36:1763-1768.
4. Pearl HK, Wang S, Gross H, et al. Telemedicine and Healthcare-A Rural Resident's Access to Stroke Treatment. The e-Journal of the South Carolina Medical Association 2005; 101: 3e-7e.
5. Alberts MJ, Hademenos G, Latchaw RE, et al. Recommendations for the establishment of primary stroke centers. Brain Attack Coalition. JAMA 2000;283: 3102-3109.
The authors had the opportunity to respond to this Correspondence but declined.