Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
Stroke. 2012 Aug;43(8):2086-90. doi: 10.1161/STROKEAHA.112.657270. Epub 2012 Jun 12.
Pre- and intrahospital time delays are major concerns in acute stroke care. Telemedicine-equipped ambulances may improve time management and identify patients with stroke eligible for thrombolysis by an early prehospital stroke diagnosis. The aims of this study were (1) to develop a telestroke ambulance prototype; (2) to test the reliability of stroke severity assessment; and (3) to evaluate its feasibility in the prehospital emergency setting.
Mobil, real-time audio-video streaming telemedicine devices were implemented into advanced life support ambulances. Feasibility of telestroke ambulances and reliability of the National Institutes of Health Stroke Scale assessment were tested using current wireless cellular communication technology (third generation) in a prehospital stroke scenario. Two stroke actors were trained in simulation of differing right and left middle cerebral artery stroke syndromes. National Institutes of Health Stroke Scale assessment was performed by a hospital-based stroke physician by telemedicine, by an emergency physician guided by telemedicine, and "a posteriori" on the basis of video documentation.
In 18 of 30 scenarios, National Institutes of Health Stroke Scale assessment could not be performed due to absence or loss of audio-video signal. In the remaining 12 completed scenarios, interrater agreement of National Institutes of Health Stroke Scale examination between ambulance and hospital and ambulance and "a posteriori" video evaluation was moderate to good with weighted κ values of 0.69 (95% CI, 0.51-0.87) and 0.79 (95% CI, 0.59-0.98), respectively.
Prehospital telestroke examination was not at an acceptable level for clinical use, at least on the basis of the used technology. Further technical development is needed before telestroke is applicable for prehospital stroke management during patient transport.
在急性脑卒中的治疗中，院前和院内的时间延误是主要关注点。配备远程医疗的救护车可以改善时间管理，并通过早期的院前卒中诊断来识别适合溶栓治疗的卒中患者。本研究的目的是：(1)开发一种远程卒中救护车原型；(2)测试卒中严重程度评估的可靠性；(3)评估其在院前急救环境中的可行性。
在高级生命支持救护车上安装了 Mobil 实时音视频远程医疗设备。使用当前的无线蜂窝通信技术（第三代），在院前卒中场景中测试远程卒中救护车的可行性和美国国立卫生研究院卒中量表评估的可靠性。两名卒中演员在模拟不同的右侧和左侧大脑中动脉卒中综合征中接受培训。由医院的卒中医生通过远程医疗、由接受远程医疗指导的急诊医生、以及根据视频记录进行的“事后”评估，对卒中量表进行评估。
在 30 个场景中，有 18 个由于音视频信号缺失或丢失而无法进行卒中量表评估。在其余 12 个完成的场景中，救护车和医院之间以及救护车和“事后”视频评估之间的卒中量表检查的组内一致性为中等至良好，加权 κ 值分别为 0.69（95%可信区间，0.51-0.87）和 0.79（95%可信区间，0.59-0.98）。
至少在使用的技术基础上，院前远程卒中检查还不能达到临床应用的可接受水平。在远程卒中适用于患者转运期间的院前卒中管理之前，还需要进一步的技术开发。
