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Stroke. 2012 Dec;43(12):3271-7. doi: 10.1161/STROKEAHA.112.669150. Epub 2012 Nov 15.

Reliability of real-time video smartphone for assessing National Institutes of Health Stroke Scale scores in acute stroke patients.

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1
Department of Neurology, Mayo Clinic, University of Arizona College of Medicine, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA. demaerschalk.bart@mayo.edu

Abstract

BACKGROUND AND PURPOSE:

Telestroke reduces acute stroke care disparities between urban stroke centers and rural hospitals. Current technologies used to conduct remote patient assessments have high start-up costs, yet they cannot consistently establish quality timely connections. Smartphones can be used for high-quality video teleconferencing. They are inexpensive and ubiquitous among health care providers. We aimed to study the reliability of high-quality video teleconferencing using smartphones for conducting the National Institutes of Health Stroke Scale (NIHSS).

METHODS:

Two vascular neurologists assessed 100 stroke patients with the NIHSS. The remote vascular neurologist assessed subjects using smartphone videoconferencing with the assistance of a bedside medical aide. The bedside vascular neurologist scored patients contemporaneously. Each vascular neurologist was blinded to the other's NIHSS scores. We tested the inter-method agreement and physician satisfaction with the device.

RESULTS:

We demonstrated high total NIHSS score correlation between the methods (r=0.949; P<0.001). The mean total NIHSS scores for bedside and remote assessments were 7.93±8.10 and 7.28±7.85, with ranges, of 0 to 35 and 0 to 37, respectively. Eight categories had high agreement: level of consciousness (questions), level of consciousness (commands), visual fields, motor left and right (arm and leg), and best language. Six categories had moderate agreement: level of consciousness (consciousness), best gaze, facial palsy, sensory, dysarthria, and extinction/inattention. Ataxia had poor agreement. There was high physician satisfaction with the smartphone.

CONCLUSIONS:

Smartphone high-quality video teleconferencing is reliable, easy to use, affordable for telestroke NIHSS administration, and has high physician satisfaction.

PMID:
23160878
DOI:
10.1161/STROKEAHA.112.669150
[Indexed for MEDLINE]
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