Telemedicine in General Neurology: Interrater Reliability of Clinical Neurological Examination Via Audio-Visual Telemedicine
Telemedicine in General Neurology: Interrater Reliability of Clinical Neurological Examination Via Audio-Visual Telemedicine
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DOI：
10.1159/000497157
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发表时间：
2018-01-01
影响因子：
2.4
通讯作者：
Handschu, Rene
中科院分区：
文献类型：
--
作者：
Awadallah, Mohamed;Janssen, Frank;Handschu, Rene
虽然有一些关于远程医疗在评估中风量表中的可靠性的研究，但对通过远程医疗进行的一般神经学检查的有效性知之甚少。因此，我们试图测试床边检查和远程检查在急诊室急性患者之间的一致性。方法：选取某450张床位的专科教学医院急症室急症患者为研究对象。临床神经学检查包括22个项目，由不同的神经科医生在床边进行，也通过视听链接远程进行；两人都是经验丰富的临床医生。对每个考题进行Kappa统计。结果：43例患者完成了两项检查，平均年龄58.3岁，女性占56%。患者在入院后8 - 72分钟（平均36.3分钟）就诊。远程检查总时间为12.6 min (8 ~ 21 min)，床边检查总时间为8.9 min （5 ~ 18 min）。k系数范围从0.32（肌肉张力）到0.82（语言），表明大多数项目的一致性相当好。结论：通过视听连接的远程检查即使在急诊室的急性患者中也能产生与床边表现相当的结果。与稀缺的可用数据相比，观察者之间的一致性与床边两名检查人员之间的一致性大致相同。然而，临床神经学检查的信度和效度还有待进一步的研究。(c) 2019 s.k ager AG，巴塞尔
Introduction: While there are several studies on reliability of telemedicine in assessing stroke scales, little is known about the validity of a general neurological examination performed via telemedicine. Therefore, we sought to test the agreement between bedside and remote examination in acute patients of the emergency room. Methods: Acute patients at the emergency room of a 450-bed academic teaching hospital were included in this study. A clinical neurological examination consisting of 22 items was performed at bedside and also remotely via an audio-visual link by a different neurologist; both were experienced clinicians at the consultant level. Kappa statistics were calculated for each item of the examination. Results: Forty three patients completed both examinations (mean age 58.3 years, 56% female). Patients were seen between 8 and 72 min after admission (mean 36.3 min). Total time for remote examination was 12.6 min (8-21 min) and 8.9 min (5-18 min) for bedside examination. K-coefficients ranged from 0.32 (muscle tone) - 0.82 (language) indicating a fair to excellent agreement in most items. Conclusions: Remote examination via an audio-visual link produces comparable results to bedside performance even in acute patients of the emergency room. Compared to the scarce data available, inter-observer agreement is about the same as that between 2 examiners at bedside. However, more studies on reliability and validity of clinical neurological examination are required. (c) 2019 S. Karger AG, Basel