Remote Assessment of Stroke Using the iPhone 4
Remote Assessment of Stroke Using the iPhone 4
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DOI：
10.1016/j.jstrokecerebrovasdis.2011.09.013
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发表时间：
2013-05-01
影响因子：
2.5
通讯作者：
Frankel, Michael
中科院分区：
文献类型：
--
作者：
Anderson, Eric R.;Smith, Bryan;Frankel, Michael
在农村医院，由于缺乏局部中风的专业知识，重组组织型纤溶酶原激活剂在治疗缺血性中风中的应用不足。当血管神经科医生不在时，中风的远程医疗解决方案是I级、A级建议。然而，目前的解决方案需要过高的启动成本，这对于最需要它们的农村医院来说是令人望而却步的。这项研究证明了使用相对便宜的iPhone4在远程中风管理中的有效性。20名中风患者在床边使用iPhone 4进行了评估，每项检查都通过另一台iPhone 4远程进行。进行床边检查的医生和远程医生都为每个患者计算了美国国立卫生研究院中风量表(NIHSS)的分数。每个医生都对对方的NIHSS评分视而不见。在评估的20名患者中，NIHSS评分从0到22。用k统计量评定评分者的信度，10项(意识水平、月份和年龄、视野、右侧运动臂、左侧运动臂、右侧运动腿、左侧运动腿、感觉、语言和忽视)一致性良好，3项一致性(凝视、面瘫和构音障碍)，1项一致性差(共济失调)。远程和床边获得的NIHSS总分具有很好的一致性(组内相关系数为0.98)。我们的发现表明，iPhone4是一种经济的移动解决方案，可以用于高保真地远程评估中风患者，并且可以很容易地整合到远程中风网络中。
Therapy with recombinant tissue plasminogen activator is underused in the treatment of ischemic stroke in rural hospitals, due to a lack of local stroke expertise. Telemedicine solutions for stroke are a level I, class A recommendation when a vascular neurologist is absent. However, current solutions require exorbitant startup costs, which are prohibitive for the rural hospitals in which they are needed most. This study demonstrates the efficacy of using the relatively inexpensive iPhone 4 in telestroke management. Twenty patients with stroke were assessed at the bedside using an iPhone 4, and each examination was directed remotely on another iPhone 4. Both the physician performing the bedside exam and the remote physician calculated a National Institutes of Health Stroke Scale (NIHSS) score for each patient. Each physician was blinded to the other's NIHSS score. In the 20 patients assessed, NIHSS scores ranged from 0 to 22. Interrater reliability assessed using the k statistic demonstrated excellent agreement in 10 items (level of consciousness, month and age, visual fields, right motor arm, left motor arm, right motor leg, left motor leg, sensation, language, and neglect), moderate agreement in 3 items (gaze, facial palsy, and dysarthria), and poor agreement in 1 item (ataxia). Total NIHSS scores obtained remotely and at bedside showed an excellent level of agreement (intraclass correlation coefficient, 0.98). Our findings indicate that the iPhone 4 is an economical mobile solution that can be used to assess stroke patients remotely with high fidelity and can be readily incorporated into a telestroke network.