Adcock Amelia K, Kosiorek Heidi, Parikh Prachi, Chauncey Alyssa, Wu Qing, Demaerschalk Bart M
1 Divisions of Cerebrovascular Diseases and Neurocritical Care, Department of Neurology, Mayo Clinic College of Medicine , Phoenix, Arizona.
2 Department of Research, Biostatistics, Mayo Clinic , Phoenix, Arizona.
Telemed J E Health. 2017 Jul;23(7):555-560. doi: 10.1089/tmj.2016.0225. Epub 2017 Jan 13.
Telemedicine is increasingly utilized in the evaluation of critically ill patients, including those with decreased level of consciousness (LOC) or coma. Improving access to providers with neurologic expertise affords earlier triage and directed patient management. However, objective data regarding the reliability of using standardized coma scales, traditionally employed at the bedside for remote assessment, are largely lacking.
Bedside and remote assessments of patients with decreased LOC, using either the Glasgow Coma Scale (GCS) or Full scale Of UnResponsiveness (FOUR), score are equivalent.
Prospective trial comparing the reliability of bedside and remote coma assessments using GCS or FOUR score clinical evaluation tools utilizing robotic telepresence technology. Total scores of the GCS and FOUR score were compared between bedside and remote physician assessors by paired t-test and Pearson correlation coefficient (PCC).
One hundred subjects were enrolled. Mean age was 70.8 (±15.9) years and the average examination time took 5.16 (±2.04) minutes. Mean GCS total score at bedside was 7.5 (±3.67) versus examination conducted remotely 7.23 (±3.85); difference in scores was 0.25 (±0.10); p = 0.01. Mean FOUR total score at bedside was 9.63 (±4.76) versus remote 9.21 (±4.74); difference in scores was 0.40 (±2.00); p = 0.05. PCC for GCS was 0.966; p < 0.001, and for FOUR score 0.912; p < 0.001. Ninety-five percent of remote providers rated GCS and 89% rated FOUR score as good (4/5) regarding overall satisfaction and ease of use.
Differences between total bedside and remote GCS and FOUR scores were small. Furthermore, PCCs between remote and bedside assessments were excellent: 0.97 (GCS) and 0.91 (FOUR). These results suggest that LOC can be reliably assessed using existing robotic telemedicine technology. Telemedicine could be adopted to help evaluate critically ill patients in neurologically underserved areas.
远程医疗在危重症患者评估中应用日益广泛，包括意识水平（LOC）降低或昏迷的患者。增加获得神经科专家的机会可实现更早的分诊和针对性的患者管理。然而，关于使用传统上在床边用于远程评估的标准化昏迷量表的可靠性的客观数据大多缺乏。
使用格拉斯哥昏迷量表（GCS）或无反应性全面量表（FOUR）对LOC降低的患者进行床边和远程评估的评分是等效的。
前瞻性试验，使用机器人远程临场技术，比较使用GCS或FOUR评分临床评估工具进行床边和远程昏迷评估的可靠性。通过配对t检验和Pearson相关系数（PCC）比较床边和远程医生评估者之间GCS和FOUR评分的总分。
共纳入100名受试者。平均年龄为70.8（±15.9）岁，平均检查时间为5.16（±2.04）分钟。床边GCS总分平均为7.5（±3.67），而远程检查为7.23（±3.85）；评分差异为0.25（±0.10）；p = 0.01。床边FOUR总分平均为9.63（±4.76），远程为9.21（±4.74）；评分差异为0.40（±2.00）；p = 0.05。GCS的PCC为0.966；p < 0.001，FOUR评分为0.912；p < 0.001。95%的远程评估者对GCS的总体满意度和易用性评分为良好（4/5），89%对FOUR评分给出同样评价。
床边和远程GCS及FOUR总分之间的差异很小。此外，远程和床边评估之间的PCC非常好：GCS为0.97，FOUR为0.91。这些结果表明，使用现有的机器人远程医疗技术可以可靠地评估LOC。远程医疗可用于帮助评估神经科服务不足地区的危重症患者。
