Ambulance-based assessment of NIH Stroke Scale with telemedicine

A feasibility pilot study

Kevin M Barrett, Michael A. Pizzi, Vivek Kesari, Sarvam P. TerKonda, Elizabeth A. Mauricio, Scott M. Silvers, Ranya Habash, Benjamin L. Brown, Rabih G. Tawk, James F Meschia, Robert Wharen, William D. Freeman

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Ischemic stroke is a time-sensitive disease, with improved outcomes associated with decreased time from onset to treatment. It was hypothesised that ambulance-based assessment of the National Institutes of Health Stroke Scale (NIHSS) using a Health Insurance Portability and Accountability Act (HIPAA)–compliant mobile platform immediately prior to arrival is feasible. Methods: This is a proof-of-concept feasibility pilot study in two phases. The first phase consisted of an ambulance-equipped HIPAA-compliant video platform for remote NIHSS assessment of a simulated stroke patient. The second phase consisted of remote NIHSS assessment by a hospital-based neurologist of acute stroke patients en route to our facility. Five ambulances were equipped with a 4G/LTE-enabled tablet preloaded with a secure HIPAA-compliant telemedicine application. Secondary outcomes assessed satisfaction of staff with the remote platform. Results: Phase one was successful in the assessment of three out of three simulated patients. Phase two was successful in the assessment of 10 out of 11 (91%) cases. One video attempt was unsuccessful because local LTE was turned off on the device. The video signal was dropped transiently due to weather, which delayed NIHSS assessment in one case. Average NIHSS assessment time was 7.6 minutes (range 3–9.8 minutes). Neurologists rated 83% of encounters as ‘satisfied’ to ‘very satisfied’, and the emergency medical service (EMS) rated 90% of encounters as ‘satisfied’ to ‘very satisfied’. The one failed video attempt was associated with ‘poor’ EMS satisfaction. Conclusion: This proof-of-concept pilot demonstrates that remote ambulance-based NIHSS assessment is feasible. This model could reduce door-to-needle times by conducting prehospital data collection.

Original languageEnglish (US)
Pages (from-to)476-483
Number of pages8
JournalJournal of Telemedicine and Telecare
Volume23
Issue number4
DOIs
StatePublished - 2017

Fingerprint

Ambulances
Telemedicine
Feasibility Studies
Stroke
National Institutes of Health (U.S.)
Health Insurance Portability and Accountability Act
Emergency Medical Services
Weather
Tablets
Needles
Equipment and Supplies

Keywords

  • acute stroke
  • Ambulance-based
  • NIH Stroke Scale
  • telemedicine

ASJC Scopus subject areas

  • Health Informatics

Cite this

Barrett, K. M., Pizzi, M. A., Kesari, V., TerKonda, S. P., Mauricio, E. A., Silvers, S. M., ... Freeman, W. D. (2017). Ambulance-based assessment of NIH Stroke Scale with telemedicine: A feasibility pilot study. Journal of Telemedicine and Telecare, 23(4), 476-483. https://doi.org/10.1177/1357633X16648490

Ambulance-based assessment of NIH Stroke Scale with telemedicine : A feasibility pilot study. / Barrett, Kevin M; Pizzi, Michael A.; Kesari, Vivek; TerKonda, Sarvam P.; Mauricio, Elizabeth A.; Silvers, Scott M.; Habash, Ranya; Brown, Benjamin L.; Tawk, Rabih G.; Meschia, James F; Wharen, Robert; Freeman, William D.

In: Journal of Telemedicine and Telecare, Vol. 23, No. 4, 2017, p. 476-483.

Research output: Contribution to journalArticle

Barrett, KM, Pizzi, MA, Kesari, V, TerKonda, SP, Mauricio, EA, Silvers, SM, Habash, R, Brown, BL, Tawk, RG, Meschia, JF, Wharen, R & Freeman, WD 2017, 'Ambulance-based assessment of NIH Stroke Scale with telemedicine: A feasibility pilot study', Journal of Telemedicine and Telecare, vol. 23, no. 4, pp. 476-483. https://doi.org/10.1177/1357633X16648490
Barrett, Kevin M ; Pizzi, Michael A. ; Kesari, Vivek ; TerKonda, Sarvam P. ; Mauricio, Elizabeth A. ; Silvers, Scott M. ; Habash, Ranya ; Brown, Benjamin L. ; Tawk, Rabih G. ; Meschia, James F ; Wharen, Robert ; Freeman, William D. / Ambulance-based assessment of NIH Stroke Scale with telemedicine : A feasibility pilot study. In: Journal of Telemedicine and Telecare. 2017 ; Vol. 23, No. 4. pp. 476-483.
@article{9baa86d38d864eabb591acce5a41184c,
title = "Ambulance-based assessment of NIH Stroke Scale with telemedicine: A feasibility pilot study",
abstract = "Background: Ischemic stroke is a time-sensitive disease, with improved outcomes associated with decreased time from onset to treatment. It was hypothesised that ambulance-based assessment of the National Institutes of Health Stroke Scale (NIHSS) using a Health Insurance Portability and Accountability Act (HIPAA)–compliant mobile platform immediately prior to arrival is feasible. Methods: This is a proof-of-concept feasibility pilot study in two phases. The first phase consisted of an ambulance-equipped HIPAA-compliant video platform for remote NIHSS assessment of a simulated stroke patient. The second phase consisted of remote NIHSS assessment by a hospital-based neurologist of acute stroke patients en route to our facility. Five ambulances were equipped with a 4G/LTE-enabled tablet preloaded with a secure HIPAA-compliant telemedicine application. Secondary outcomes assessed satisfaction of staff with the remote platform. Results: Phase one was successful in the assessment of three out of three simulated patients. Phase two was successful in the assessment of 10 out of 11 (91{\%}) cases. One video attempt was unsuccessful because local LTE was turned off on the device. The video signal was dropped transiently due to weather, which delayed NIHSS assessment in one case. Average NIHSS assessment time was 7.6 minutes (range 3–9.8 minutes). Neurologists rated 83{\%} of encounters as ‘satisfied’ to ‘very satisfied’, and the emergency medical service (EMS) rated 90{\%} of encounters as ‘satisfied’ to ‘very satisfied’. The one failed video attempt was associated with ‘poor’ EMS satisfaction. Conclusion: This proof-of-concept pilot demonstrates that remote ambulance-based NIHSS assessment is feasible. This model could reduce door-to-needle times by conducting prehospital data collection.",
keywords = "acute stroke, Ambulance-based, NIH Stroke Scale, telemedicine",
author = "Barrett, {Kevin M} and Pizzi, {Michael A.} and Vivek Kesari and TerKonda, {Sarvam P.} and Mauricio, {Elizabeth A.} and Silvers, {Scott M.} and Ranya Habash and Brown, {Benjamin L.} and Tawk, {Rabih G.} and Meschia, {James F} and Robert Wharen and Freeman, {William D.}",
year = "2017",
doi = "10.1177/1357633X16648490",
language = "English (US)",
volume = "23",
pages = "476--483",
journal = "Journal of Telemedicine and Telecare",
issn = "1357-633X",
publisher = "SAGE Publications Ltd",
number = "4",

}

TY - JOUR

T1 - Ambulance-based assessment of NIH Stroke Scale with telemedicine

T2 - A feasibility pilot study

AU - Barrett, Kevin M

AU - Pizzi, Michael A.

AU - Kesari, Vivek

AU - TerKonda, Sarvam P.

AU - Mauricio, Elizabeth A.

AU - Silvers, Scott M.

AU - Habash, Ranya

AU - Brown, Benjamin L.

AU - Tawk, Rabih G.

AU - Meschia, James F

AU - Wharen, Robert

AU - Freeman, William D.

PY - 2017

Y1 - 2017

N2 - Background: Ischemic stroke is a time-sensitive disease, with improved outcomes associated with decreased time from onset to treatment. It was hypothesised that ambulance-based assessment of the National Institutes of Health Stroke Scale (NIHSS) using a Health Insurance Portability and Accountability Act (HIPAA)–compliant mobile platform immediately prior to arrival is feasible. Methods: This is a proof-of-concept feasibility pilot study in two phases. The first phase consisted of an ambulance-equipped HIPAA-compliant video platform for remote NIHSS assessment of a simulated stroke patient. The second phase consisted of remote NIHSS assessment by a hospital-based neurologist of acute stroke patients en route to our facility. Five ambulances were equipped with a 4G/LTE-enabled tablet preloaded with a secure HIPAA-compliant telemedicine application. Secondary outcomes assessed satisfaction of staff with the remote platform. Results: Phase one was successful in the assessment of three out of three simulated patients. Phase two was successful in the assessment of 10 out of 11 (91%) cases. One video attempt was unsuccessful because local LTE was turned off on the device. The video signal was dropped transiently due to weather, which delayed NIHSS assessment in one case. Average NIHSS assessment time was 7.6 minutes (range 3–9.8 minutes). Neurologists rated 83% of encounters as ‘satisfied’ to ‘very satisfied’, and the emergency medical service (EMS) rated 90% of encounters as ‘satisfied’ to ‘very satisfied’. The one failed video attempt was associated with ‘poor’ EMS satisfaction. Conclusion: This proof-of-concept pilot demonstrates that remote ambulance-based NIHSS assessment is feasible. This model could reduce door-to-needle times by conducting prehospital data collection.

AB - Background: Ischemic stroke is a time-sensitive disease, with improved outcomes associated with decreased time from onset to treatment. It was hypothesised that ambulance-based assessment of the National Institutes of Health Stroke Scale (NIHSS) using a Health Insurance Portability and Accountability Act (HIPAA)–compliant mobile platform immediately prior to arrival is feasible. Methods: This is a proof-of-concept feasibility pilot study in two phases. The first phase consisted of an ambulance-equipped HIPAA-compliant video platform for remote NIHSS assessment of a simulated stroke patient. The second phase consisted of remote NIHSS assessment by a hospital-based neurologist of acute stroke patients en route to our facility. Five ambulances were equipped with a 4G/LTE-enabled tablet preloaded with a secure HIPAA-compliant telemedicine application. Secondary outcomes assessed satisfaction of staff with the remote platform. Results: Phase one was successful in the assessment of three out of three simulated patients. Phase two was successful in the assessment of 10 out of 11 (91%) cases. One video attempt was unsuccessful because local LTE was turned off on the device. The video signal was dropped transiently due to weather, which delayed NIHSS assessment in one case. Average NIHSS assessment time was 7.6 minutes (range 3–9.8 minutes). Neurologists rated 83% of encounters as ‘satisfied’ to ‘very satisfied’, and the emergency medical service (EMS) rated 90% of encounters as ‘satisfied’ to ‘very satisfied’. The one failed video attempt was associated with ‘poor’ EMS satisfaction. Conclusion: This proof-of-concept pilot demonstrates that remote ambulance-based NIHSS assessment is feasible. This model could reduce door-to-needle times by conducting prehospital data collection.

KW - acute stroke

KW - Ambulance-based

KW - NIH Stroke Scale

KW - telemedicine

UR - http://www.scopus.com/inward/record.url?scp=85019117491&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019117491&partnerID=8YFLogxK

U2 - 10.1177/1357633X16648490

DO - 10.1177/1357633X16648490

M3 - Article

VL - 23

SP - 476

EP - 483

JO - Journal of Telemedicine and Telecare

JF - Journal of Telemedicine and Telecare

SN - 1357-633X

IS - 4

ER -