Lippman Jason M, Smith Sherita N Chapman, McMurry Timothy L, Sutton Zachary G, Gunnell Brian S, Cote Jack, Perina Debra G, Cattell-Gordon David C, Rheuban Karen S, Solenski Nina J, Worrall Bradford B, Southerland Andrew M
1 Department of Neurology, University of Virginia Health System , Charlottesville, Virginia.
2 Department of Neurology, Virginia Commonwealth University Health System , Richmond, Virginia.
Telemed J E Health. 2016 Jun;22(6):507-13. doi: 10.1089/tmj.2015.0155. Epub 2015 Nov 24.
The use of telemedicine in the diagnosis and treatment of acute stroke, or telestroke, is a well-accepted method of practice improving geographic disparities in timely access to neurological expertise. We propose that mobile telestroke assessment during ambulance transport is feasible using low-cost, widely available technology.
We designed a platform including a tablet-based end point, high-speed modem with commercial wireless access, external antennae, and portable mounting apparatus. Mobile connectivity testing was performed along six primary ambulance routes in a rural network. Audiovisual (AV) quality was assessed simultaneously by both an in-vehicle and an in-hospital rater using a standardized 6-point rating scale (≥4 indicating feasibility). We sought to achieve 9 min of continuous AV connectivity presumed sufficient to perform mobile telestroke assessments.
Thirty test runs were completed: 93% achieved a minimum of 9 min of continuous video transmission with a mean mobile connectivity time of 18 min. Mean video and audio quality ratings were 4.51 (4.54 vehicle; 4.48 hospital) and 5.00 (5.13 in-vehicle; 4.87 hospital), respectively. Total initial cost of the system was $1,650 per ambulance.
In this small, single-centered study we maintained high-quality continuous video transmission along primary ambulance corridors using a low-cost mobile telemedicine platform. The system is designed to be portable and adaptable, with generalizability for rapid assessment of emergency conditions in which direct observational exam may improve prehospital diagnosis and treatment. Thus mobile telestroke assessment is feasible using low-cost components and commercial wireless connectivity. More research is needed to demonstrate clinical reliability and efficacy in a live-patient setting.
远程医疗在急性卒中的诊断和治疗中应用，即远程卒中，是一种被广泛认可的实践方法，可改善及时获得神经科专业知识方面的地理差异。我们提出，在救护车转运过程中进行移动远程卒中评估，使用低成本、广泛可用的技术是可行的。
我们设计了一个平台，包括基于平板电脑的终端、带有商业无线接入的高速调制解调器、外部天线和便携式安装设备。在一个农村网络的六条主要救护路线上进行了移动连接测试。车内和医院的评估人员同时使用标准化的6分制评分量表（≥4分表示可行）对视听（AV）质量进行评估。我们力求实现9分钟的连续AV连接，假定这足以进行移动远程卒中评估。
完成了30次测试运行：93%的测试实现了至少9分钟的连续视频传输，平均移动连接时间为18分钟。视频和音频质量的平均评分分别为4.51（车内4.54；医院4.48）和5.00（车内5.13；医院4.87）。该系统每辆救护车的初始总成本为1650美元。
在这项小型单中心研究中，我们使用低成本移动远程医疗平台在主要救护走廊上保持了高质量的连续视频传输。该系统设计为便携式且适应性强，具有广泛适用性，可用于快速评估紧急情况，在这些情况下直接观察检查可能会改善院前诊断和治疗。因此，使用低成本组件和商业无线连接进行移动远程卒中评估是可行的。需要更多研究来证明在真实患者环境中的临床可靠性和有效性。
