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(Stroke. 2003;34:e191.)
© 2003 American Heart Association, Inc.

Research Reports

Editorial Comment—Remote Evaluation of Acute Ischemic Stroke: A Reliable Tool to Extend Tissue Plasminogen Activator Use to Community and Rural Stroke Patients?

Department of Neurology, University Hospital Göttingen, Göttingen, Germany

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In order to apply thrombolytic therapy to patients presenting with an acute stroke in community hospitals without permanent access to consulting neurologists, Wang et al report an interesting replenishment of the classic stroke unit concept. They present an easy-to-use video evaluation tool, which allows the raising of a bedside NIHSS score remotely. According to their data, this remote NIHSS score strongly correlates with the NIHSS score evaluated by a blinded bedside investigator. Although remote evaluation of NIHSS by telemedicine has been reported before,¹ the technical approach presented here may allow scoring under more real-life conditions. Nevertheless, the small number of 20 patients can only serve as a proof of principle, since an evaluation especially of patients with complex deficits like neglect, other neuropsychological deficits, or visual field defects might be challenging even under real-life conditions, which means examination in the short 3-hour time window.

Moreover, the NIHSS is only one critical step in the decision about a thrombolytic therapy, according to the NINDS criteria. It remains to be shown by the already ongoing trial that remote evaluation of NIHSS and, even more critical, of the CT scan will lead to reliable and safe decisions about intravenous rtPA administration in this setting. Another fundamental disadvantage of remote evaluation is the fact that examination of the patient is restricted to one given time point. This neglects the fact that many patients present not with stable but with fluctuating, decreasing or increasing deficits that complicate the decision about thrombolytic therapy in everyday life. . . . [Full Text of this Article]