This Article Full Text Full Text (PDF) All Versions of this Article: 34/10/e188    most recent 01.STR.0000091847.82140.9Dv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, S. Articles by Adams, R. J. Search for Related Content PubMed PubMed Citation Articles by Wang, S. Articles by Adams, R. J. Related Collections Acute Cerebral Hemorrhage Acute Cerebral Infarction Emergency treatment of Stroke Computerized tomography and Magnetic Resonance Imaging Thrombolysis

(Stroke. 2003;34:e188.)
© 2003 American Heart Association, Inc.

Research Reports

Remote Evaluation of Acute Ischemic Stroke

Reliability of National Institutes of Health Stroke Scale via Telestroke

Sam Wang, MS; Sung Bae Lee, MD; Carol Pardue, MSN; Davinder Ramsingh, BS; Jennifer Waller, PhD; Hartmut Gross, MD; Fenwick T. Nichols, III, MD; David C. Hess, MD Robert J. Adams, MS, MD

From the Medical College of Georgia, Augusta.

Correspondence to Sam Wang, MS, Department of Neurology, Medical College of Georgia, 1429 Harper St, Bldg HF-1154, Augusta, GA 30912. E-mail swang{at}mail.mcg.edu

Background and Purpose— Despite Food and Drug Administration approval of tissue-type plasminogen activator for stroke, obstacles in the US healthcare system prevent its widespread use. The Remote Evaluation for Acute Ischemic Stroke (REACH) program was developed to address these issues in rural settings. A key component of stroke assessment in the REACH system is the National Institutes of Health Stroke Scale (NIHSS) evaluation. We sought to determine whether, using the REACH system, NIHSS values of bedside and remote evaluators would correspond.

Methods— Twenty patients were recruited. On obtaining consent, a neurologist performed a bedside NIHSS evaluation on each patient. Within 1 hour, using any broadband-connected workstation—either office or home personal computer and a landline phone to speak with the patient—a second neurologist remotely evaluated the patient through the REACH system. Paired t tests and Pearson correlation coefficients were used to examine NIHSS reliability performed bedside and remotely.

Results— NIHSS ranged from 1 to 24. Correlations between bedside and remote locations (r=0.9552, P=0.0001) were very strong, and t tests indicate that the means were not different.

Conclusions— The NIHSS can be reliably performed over the REACH system. This supports our endeavor to bring stroke expertise to rural community hospitals.

Key Words: reproducibility of results • stroke assessment • stroke, ischemic • telemedicine

This article has been cited by other articles:

				H. Gross, C. Hall, J. A. Switzer, R. J. Adams, S. Wang, D. C. Hess, F. T. Nichols, C. Pardue, and L. L. Edwards USING TPA FOR ACUTE STROKE IN A RURAL SETTING Neurology, May 29, 2007; 68(22): 1957 - 1958. [Full Text] [PDF]

				R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Circulation, March 14, 2006; 113(10): e409 - e449. [Abstract] [Full Text] [PDF]

				L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, P. W. Duncan, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Circulation, March 1, 2005; 111(8): 1078 - 1091. [Full Text] [PDF]