Published Online
on November 13, 2003

A more recent version of this article appeared on December 1, 2003

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Submitted on August 10, 2003
Accepted on August 14, 2003

Telemedicine in Emergency Evaluation of Acute Stroke. Interrater Agreement in Remote Video Examination With a Novel Multimedia System

René Handschu MD^*; Rebekka Littmann MD; Udo Reulbach MD; Charly Gaul MD; Josef G. Heckmann MD; Bernhard Neundörfer MD, PhD; and Mateusz Scibor MSc

From the Department of Neurology (R.H., R.L., C.G, J.G.H, B.N), Neurocenter (R.H., M.S.), and Department of Medical Informatics, Biometry and Epidemiology (U.R.), Friedrich Alexander Universitaet, Erlangen-Nuremberg, Germany.

^* To whom correspondence should be addressed. E-mail: rene.handschu{at}neuro.med.uni-erlangen.de.

Background and Purpose--In acute stroke care, rapid but careful evaluation of patients is mandatory but requires an experienced stroke neurologist. Telemedicine offers the possibility of bringing such expertise quickly to more patients. This study tested for the first time whether remote video examination is feasible and reliable when applied in emergency stroke care using the National Institutes of Health Stroke Scale (NIHSS).

Methods--We used a novel multimedia telesupport system for transfer of real-time video sequences and audio data. The remote examiner could direct the set-top camera and zoom from distant overviews to close-ups from the personal computer in his office. Acute stroke patients admitted to our stroke unit were examined on admission in the emergency room. Standardized examination was performed by use of the NIHSS (German version) via telemedicine and compared with bedside application.

Results--In this pilot study, 41 patients were examined. Total examination time was 11.4 minutes on average (range, 8 to 18 minutes). None of the examinations had to be stopped or interrupted for technical reasons, although minor problems (brightness, audio quality) with influence on the examination process occurred in 2 sessions. Unweighted coefficients ranged from 0.44 to 0.89; weighted coefficients, from 0.85 to 0.99.

Conclusions--Remote examination of acute stroke patients with a computer-based telesupport system is feasible and reliable when applied in the emergency room; interrater agreement was good to excellent in all items. For more widespread use, some problems that emerge from details like brightness, optimal camera position, and audio quality should be solved.

Key words: diagnosis • stroke management • stroke, acute • telemedicine

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