From the Department of Neurology, University of Texas-Health Science Center at Houston (T.-C.W., C.N., C.A., F.V., J.C.G., S.I.S.); Department of Neurology, University of Texas Southwestern Medical Center, Dallas (J.Y.); and Department of Medicine (D.P.) and Department of Surgery (D.P.), Baylor College of Medicine, Houston, TX.
Stroke. 2014 Aug;45(8):2342-7. doi: 10.1161/STROKEAHA.114.005193. Epub 2014 Jun 17.
Prehospital evaluation using telemedicine may accelerate acute stroke treatment with tissue-type plasminogen activator. We explored the feasibility and reliability of using telemedicine in the field and ambulance to help evaluate acute stroke patients.
Ten unique, scripted stroke scenarios, each conducted 4 times, were portrayed by trained actors retrieved and transported by Houston Fire Department emergency medical technicians to our stroke center. The vascular neurologists performed remote assessments in real time, obtaining clinical data points and National Institutes of Health (NIH) Stroke Scale, using the In-Touch RP-Xpress telemedicine device. Each scripted scenario was recorded for a subsequent evaluation by a second blinded vascular neurologist. Study feasibility was defined by the ability to conduct 80% of the sessions without major technological limitations. Reliability of video interpretation was defined by a 90% concordance between the data derived during the real-time sessions and those from the scripted scenarios.
In 34 of 40 (85%) scenarios, the teleconsultation was conducted without major technical complication. The absolute agreement for intraclass correlation was 0.997 (95% confidence interval, 0.992-0.999) for the NIH Stroke Scale obtained during the real-time sessions and 0.993 (95% confidence interval, 0.975-0.999) for the recorded sessions. Inter-rater agreement using κ-statistics showed that for live-raters, 10 of 15 items on the NIH Stroke Scale showed excellent agreement and 5 of 15 showed moderate agreement. Matching of real-time assessments occurred for 88% (30/34) of NIH Stroke Scale scores by ±2 points and 96% of the clinical information.
Mobile telemedicine is reliable and feasible in assessing actors simulating acute stroke in the prehospital setting.
通过远程医疗对患者进行院前评估，可能会加速急性脑卒中患者接受组织型纤溶酶原激活剂治疗的进程。本研究旨在探讨在现场和救护车上使用远程医疗技术帮助评估急性脑卒中患者的可行性和可靠性。
10 个独特的、脚本化的脑卒中场景由经过培训的演员扮演，由休斯顿消防局的急救医疗技术员检索并运送至我们的卒中中心。血管神经科医生使用 In-Touch RP-Xpress 远程医疗设备实时进行远程评估，获取临床数据点和美国国立卫生研究院卒中量表（NIHSS）评分。每个脚本化场景都被记录下来，以便随后由第二位盲法血管神经科医生进行评估。研究可行性定义为能够在无重大技术限制的情况下完成 80%的场次。视频解读的可靠性定义为实时场次中得出的数据与脚本化场景中得出的数据之间的一致性达到 90%。
在 40 个场景中的 34 个（85%）中，远程会诊没有出现重大技术并发症。实时场次中获得的 NIHSS 评分的组内相关系数的绝对一致性为 0.997（95%置信区间，0.992-0.999），记录场次中的一致性为 0.993（95%置信区间，0.975-0.999）。使用κ统计量的组间一致性显示，对于实时评分者，NIHSS 量表的 15 项中有 10 项具有极好的一致性，5 项具有中度一致性。实时评估与 NIHSS 评分的匹配情况为 88%（30/34），2 分以内匹配，96%的临床信息匹配。
在院前环境中，移动远程医疗技术可用于可靠且准确地评估模拟急性脑卒中的演员。
