Abstract TP250: Defining Technical Quality Standards for Mobile Telestroke Assessment: A Substudy of the Improving Treatment with Rapid Evaluation of Acute Stroke via Mobile Telemedicine (iTREAT) Mobile Telestroke Platform
Introduction: In-ambulance use of remote videoconferencing for prehospital stroke assessment (mobile telestroke) is an emerging innovation in acute stroke care. As a new technology, there is a dearth of technical standards to ensure transmission quality and guide deployment in various EMS settings.
Hypothesis: Subjective video quality ratings during in-vehicle mobile telestroke assessment correlate to objective video data transmission metrics.
Methods: We performed videoconferencing via a low-cost, utilitarian mobile telestroke platform: tablet endpoint, high-speed 4G LTE modem, external antennae, HIPAA-secure videoconferencing application, and portable bracket mounting. We held test calls along typical ambulance routes recording transmission quality by a stationary and a mobile rater. We used a standardized 6-point scale of video quality: rating ≥ 4 deemed acceptable for mobile telestroke assessment. We recorded jitter, the variance in transmission data reception order, as simultaneously reported by the videoconferencing application.
Results: We completed five test runs yielding 64 data ratings. Average jitter for ratings 1 through 6 was 434.9ms (SD = 407), 106.1ms (SD = 110), 41.4ms (SD = 29), 35.3ms (SD = 15), 29.5ms (SD = 6), and 29.0ms (SD = 2) respectively. Analyzing the raw data yielded an R2 of 0.41. As seen in Chart 1, video quality decreased as average jitter increased, but jitter values as low as 30ms were still seen across video transmission of all qualities.
Conclusion: These preliminary data suggest modest correlation of transmission variance with subjective quality ratings using a low-cost mobile telestroke platform along rural-based ambulance routes. However, average transmission variance correlated highly (R2 = 0.93) suggesting more data ratings may improve the correlation. Testing of our mobile telestroke platform to assess performance and clinical efficacy as well as incorporate live acute stroke encounters is ongoing.
Author Disclosures: J.M. Lippman: Other; Modest; Recipient of a Student Scholarship in Cerebrovascular Disease and Stroke. Z.G. Sutton: None. T.L. McMurry: None. B. Gunnell: Ownership Interest; Modest; U.S. Provisional Patent Application Serial No. 61/867,477. J. Cote: None. N.J. Solenski: Research Grant; Modest; HRSA GO1RH27869-01-00. S. Chapman Smith: Ownership Interest; Modest; U.S. Provisional Patent Application Serial No. 61/867,477. B.B. Worrall: Employment; Modest; Associate Editor, Neurology. A.M. Southerland: Employment; Modest; Deputy Editor, Neurology Podcast. Research Grant; Modest; HRSA GO1RH27869-01-00, UVA Neuroscience Center of Excellence. Other Research Support; Modest; American Academy of Neurology, Virginia Alliance of Emergency Medical Research, American Board of Psychiatry and Neurology. Expert Witness; Modest; Legal expert review. Ownership Interest; Modest; U.S. Provisional Patent Application Serial No. 61/867,477. Other; Modest; Speaker, America's Essential Hospitals.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2016 by American Heart Association, Inc.