Telemedicine Can Replace the Neurologist on a Mobile Stroke Unit.

Abstract

BACKGROUND AND PURPOSE:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

Remote telemedicine vascular neurologist assessment is reliable and accurate, supporting either telemedicine vascular neurologist or onboard vascular neurologist assessment on our mobile stroke unit.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02190500.

• Authors: Tzu-Ching Wu, Stephanie A Parker, Amanda Jagolino, Jose-Miguel Yamal, Ritvij Bowry, Abraham Thomas, Amy Yu, James C Grotta
• Journal: Stroke (Stroke) Vol. 48 Issue 2 Pg. 493-496 (02 2017) ISSN: 1524-4628 [Electronic] United States
• PMID: 28082671 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2017 American Heart Association, Inc.

Chemical References

• Tissue Plasminogen Activator

Topics

• Aged
• Aged, 80 and over
• Emergency Medical Services (methods, trends)
• Female
• Humans
• Male
• Middle Aged
• Mobile Health Units (trends)
• Neurologists (trends)
• Pilot Projects
• Stroke (diagnostic imaging, therapy)
• Telemedicine (methods, trends)
• Tissue Plasminogen Activator (administration & dosage)
• Tomography, X-Ray Computed