A low-cost, tablet-based option for prehospital neurologic assessment
A low-cost, tablet-based option for prehospital neurologic assessment
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用于院前神经系统评估的基于平板电脑的低成本选项
作者：
Sherita Chapman Smith;Prasanthi Govindarajan;M. Padrick;J. Lippman;T. McMurry;Brian Resler;Kevin J. Keenan;B. Gunnell;P. Mehndiratta;Christina Chee;E. Cahill;Cameron Dietiker;D. Cattell;Wade S. Smith;D. Perina;N. Solenski;B. Worrall;A. Southerland
目的：在这项双中心研究中，我们评估了用于救护车运输的低成本、基于平板电脑的移动的远程卒中选项的技术可行性和可靠性，并假设远程和床旁检查的NIH卒中量表（NIHSS）的可靠性相似。研究方法：我们在弗吉尼亚州中部和旧金山弗朗西斯科湾区这两个地理区域试用了我们的移动的远程医疗系统，利用商用蜂窝网络进行视频会议传输。标准化患者在救护车运输过程中描绘了脚本中风场景，并由独立评估者进行评价，比较床边和远程移动的远程中风评估。我们使用混合效应回归模型来确定床旁和远程检查之间NIHSS的组内相关性（95%置信区间）。结果如下：我们在两个研究中心进行了27次救护车运行，并成功完成了所有院前评估的NIHSS，没有出现禁止性的技术中断。床旁（面对面）和远程（视频）NIHSS评分之间的平均差异为0.25（1.00至-0.50）。总体而言，床旁和移动的远程卒中评估之间的NIHSS相关性为0.96（0.92-0.98）。在混合效应回归模型中，评价方法或研究中心之间的差异无统计学显著性差异。结论：利用低成本的平板电脑平台和商用蜂窝网络，我们可以在农村和城市环境中可靠地进行院前神经病学评估。需要进一步的研究来建立院前移动的远程中风评估的可靠性和有效性，在现场病人提出的急性神经症状。
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.