Abstract T P196: The Feasibility of iPad Technology for Remote Stroke Assessment Within a Moving Ambulance

Abstract

Several regional telestroke systems now exist to remotely assess stroke patients at community hospitals via wireless technology in order to decrease the time between stroke onset and treatment. More recently, mobile applications have been studied yet the wireless technology was not sufficient to support reliable audiovisual transmission. This study assessed the feasibility of remote stroke assessment via an iPad within a moving ambulance. Connectivity, quality of transmission, and interrater agreement were examined. Using routes between five spoke rural community hospitals and a telemedicine hub hospital in Fort Wayne, Indiana (radius of approximately 45 miles), two blinded, certified NIH Stroke Scale (NIHSS) raters conducted 30 stroke assessments on a standardized patient. An iPad was mounted within an ambulance and the standardized patient was examined by both in-person and remote assessors. The study demonstrated feasibility in 84% of the assessments with kappa coefficient analysis demonstrating strong interrater agreement for subscales with the exceptions of Best Language and Motor Right Leg. The assessors’ total NIHSS scores were found to have an 88% agreement to the expected scores. When compared to the expected NIHSS scores, subscales showed strong agreement, except moderate agreement in the Best Language subscale. The results of this feasibility study demonstrate that remote NIHSS assessments based within a moving ambulance were feasible. This success rate supports further study of the application in a real, live clinical setting.