A low-cost, tablet-based option for prehospital neurologic assessment

Sherita N.Chapman Smith, Prasanthi Govindarajan, Matthew M. Padrick, Jason M. Lippman, Timothy L. McMurry, Brian L. Resler, Kevin Keenan, Brian S. Gunnell, Prachi Mehndiratta, Christina Y. Chee, Elizabeth A. Cahill, Cameron Dietiker, David C. Cattell-Gordon, Wade S. Smith, Debra G. Perina, Nina J. Solenski, Bradford B. Worrall, Andrew M. Southerland

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objectives: In this 2-center study, we assessed the technical feasibility and reliability of a low cost, tablet-based mobile telestroke option for ambulance transport and hypothesized that the NIH Stroke Scale (NIHSS) could be performed with similar reliability between remote and bedside examinations. Methods: We piloted our mobile telemedicine system in 2 geographic regions, central Virginia and the San Francisco Bay Area, utilizing commercial cellular networks for videoconferencing transmission. Standardized patients portrayed scripted stroke scenarios during ambulance transport and were evaluated by independent raters comparing bedside to remote mobile telestroke assessments. We used a mixed-effects regression model to determine intraclass correlation of the NIHSS between bedside and remote examinations (95% confidence interval). Results: We conducted 27 ambulance runs at both sites and successfully completed the NIHSS for all prehospital assessments without prohibitive technical interruption. The mean difference between bedside (face-to-face) and remote (video) NIHSS scores was 0.25 (1.00 to -0.50). Overall, correlation of the NIHSS between bedside and mobile telestroke assessments was 0.96 (0.92-0.98). In the mixed-effects regression model, there were no statistically significant differences accounting for method of evaluation or differences between sites. Conclusions: Utilizing a low-cost, tablet-based platform and commercial cellular networks, we can reliably perform prehospital neurologic assessments in both rural and urban settings. Further research is needed to establish the reliability and validity of prehospital mobile telestroke assessment in live patients presenting with acute neurologic symptoms.

Original languageEnglish (US)
Pages (from-to)19-26
Number of pages8
JournalNeurology
Volume87
Issue number1
DOIs
StatePublished - Jul 5 2016
Externally publishedYes

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Nervous System
Tablets
Stroke
Costs and Cost Analysis
Ambulances
Videoconferencing
San Francisco
Telemedicine
Neurologic Manifestations
Reproducibility of Results
Confidence Intervals
Research

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Smith, S. N. C., Govindarajan, P., Padrick, M. M., Lippman, J. M., McMurry, T. L., Resler, B. L., ... Southerland, A. M. (2016). A low-cost, tablet-based option for prehospital neurologic assessment. Neurology, 87(1), 19-26. https://doi.org/10.1212/WNL.0000000000002799

A low-cost, tablet-based option for prehospital neurologic assessment. / Smith, Sherita N.Chapman; Govindarajan, Prasanthi; Padrick, Matthew M.; Lippman, Jason M.; McMurry, Timothy L.; Resler, Brian L.; Keenan, Kevin; Gunnell, Brian S.; Mehndiratta, Prachi; Chee, Christina Y.; Cahill, Elizabeth A.; Dietiker, Cameron; Cattell-Gordon, David C.; Smith, Wade S.; Perina, Debra G.; Solenski, Nina J.; Worrall, Bradford B.; Southerland, Andrew M.

In: Neurology, Vol. 87, No. 1, 05.07.2016, p. 19-26.

Research output: Contribution to journalArticle

Smith, SNC, Govindarajan, P, Padrick, MM, Lippman, JM, McMurry, TL, Resler, BL, Keenan, K, Gunnell, BS, Mehndiratta, P, Chee, CY, Cahill, EA, Dietiker, C, Cattell-Gordon, DC, Smith, WS, Perina, DG, Solenski, NJ, Worrall, BB & Southerland, AM 2016, 'A low-cost, tablet-based option for prehospital neurologic assessment', Neurology, vol. 87, no. 1, pp. 19-26. https://doi.org/10.1212/WNL.0000000000002799
Smith SNC, Govindarajan P, Padrick MM, Lippman JM, McMurry TL, Resler BL et al. A low-cost, tablet-based option for prehospital neurologic assessment. Neurology. 2016 Jul 5;87(1):19-26. https://doi.org/10.1212/WNL.0000000000002799
Smith, Sherita N.Chapman ; Govindarajan, Prasanthi ; Padrick, Matthew M. ; Lippman, Jason M. ; McMurry, Timothy L. ; Resler, Brian L. ; Keenan, Kevin ; Gunnell, Brian S. ; Mehndiratta, Prachi ; Chee, Christina Y. ; Cahill, Elizabeth A. ; Dietiker, Cameron ; Cattell-Gordon, David C. ; Smith, Wade S. ; Perina, Debra G. ; Solenski, Nina J. ; Worrall, Bradford B. ; Southerland, Andrew M. / A low-cost, tablet-based option for prehospital neurologic assessment. In: Neurology. 2016 ; Vol. 87, No. 1. pp. 19-26.
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AU - Govindarajan, Prasanthi

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AU - McMurry, Timothy L.

AU - Resler, Brian L.

AU - Keenan, Kevin

AU - Gunnell, Brian S.

AU - Mehndiratta, Prachi

AU - Chee, Christina Y.

AU - Cahill, Elizabeth A.

AU - Dietiker, Cameron

AU - Cattell-Gordon, David C.

AU - Smith, Wade S.

AU - Perina, Debra G.

AU - Solenski, Nina J.

AU - Worrall, Bradford B.

AU - Southerland, Andrew M.

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