NIH Stroke Scale Assessment via Tablet-based Mobile Telestroke During Ambulance Transport Is Feasible - pilot data from the Improving Treatment with Rapid Evaluation of Acute stroke via mobile Telemedecine (iTREAT) study (S21.003)

OBJECTIVE: We hypothesize that our low-cost mobile telestroke system is clinically reliable to perform the NIH Stroke Scale (NIHSS) during ambulance transport (iTREAT) compared to face-to-face (FTF) assessment. BACKGROUND: With an emphasis on more rapid diagnosis and treatment, acute stroke care and research is moving into the prehospital setting. DESIGN/METHODS: The iTREAT system comprises an Apple iPad with retina display, stretcher-clamped cradle mount, high-speed 4G LTE modem, magnetic-mount external antenna, secure Cisco Jabber videoconferencing application, and our regional Verizon Wireless network. Six unique stroke scenarios were created to best emulate real life EMS prehospital stroke alerts. Three standardized patients were recruited and randomly assigned two scenarios each tested along six major ambulance routes triaging to UVA Medical Center. We alternated the order of FTF and iTREAT evaluations. Statistical analysis included a mixed effects regression model, adjusting for scenario, rater, and order of exposure, to estimate the difference between FTF and iTREAT scores. Inter-rater and intra-rater agreement was measured using correlation statistics (95[percnt] CI) and Bland Altman plots. Qualitative measures of mean/median audiovisual (AV) quality was determined on a 6-point rating scale (>4 indicating technical feasibility). RESULTS: Overall, the intraclass correlation between iTREAT and FTF assessments was 0.98 (0.94, 1.00). Bland-Altman plots showed that ambulance estimates tended to be slightly higher than FTF, but the difference in NIHSS scores was not significantly different 0.32 (−0.33, 0.98). AV quality ratings during all iTREAT evaluations were deemed “good” or “excellent” (audio mean=5.3, median=5.5; video mean=4.67, median=4.5). Both the NIHSS correlation and AV quality rating increased over the study period. CONCLUSIONS: In this simulation study, NIHSS scores performed during rural ambulance transport using our low-cost, off-the-shelf tablet-based mobile telestroke system correlated well with face-to-face assessments. These results support further prospective research of mobile telemedicine in live patient settings of prehospital stroke care. Disclosure: Dr. Padrick has received research support from the American Heart Association. Dr. Chapman has received research support from Virginia Alliance for Emergency Medical Education and Research. Dr. McMurry has nothing to disclose. Dr. Mehndiratta has nothing to disclose. Dr. Chee has nothing to disclose. Dr. Gunnell has nothing to disclose. Dr. Kimble has nothing to disclose. Dr. Cote has nothing to disclose. Dr. Lippman has nothing to disclose. Dr. Burke has nothing to disclose. Dr. Catell-Gordon has nothing to disclose. Dr. Rheuban has nothing to disclose. Dr. Solenski has nothing to disclose. Dr. Perina has nothing to disclose. Dr. Worrall has received personal compensation in an editorial capacity for Neurology. Dr. Worrall has received royalty payments from Merritt9s Neurology. Dr. Southerland has received personal compensation in an editorial capacity for Neurology Podcast.