Reliability of real-time video smartphone for assessing National Institutes of Health Stroke Scale scores in acute stroke patients.
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Date
2012-11-27
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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 PUnder0 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