Dataset Information

A low-cost, tablet-based option for prehospital neurologic assessment: The iTREAT Study.

ABSTRACT:

Objectives

In this 2-center study, we assessed the technical feasibility and reliability of a low cost, tablet-based mobile telestroke option for ambulance transport and hypothesized that the NIH Stroke Scale (NIHSS) could be performed with similar reliability between remote and bedside examinations.

Methods

We piloted our mobile telemedicine system in 2 geographic regions, central Virginia and the San Francisco Bay Area, utilizing commercial cellular networks for videoconferencing transmission. Standardized patients portrayed scripted stroke scenarios during ambulance transport and were evaluated by independent raters comparing bedside to remote mobile telestroke assessments. We used a mixed-effects regression model to determine intraclass correlation of the NIHSS between bedside and remote examinations (95% confidence interval).

Results

We conducted 27 ambulance runs at both sites and successfully completed the NIHSS for all prehospital assessments without prohibitive technical interruption. The mean difference between bedside (face-to-face) and remote (video) NIHSS scores was 0.25 (1.00 to -0.50). Overall, correlation of the NIHSS between bedside and mobile telestroke assessments was 0.96 (0.92-0.98). In the mixed-effects regression model, there were no statistically significant differences accounting for method of evaluation or differences between sites.

Conclusions

Utilizing a low-cost, tablet-based platform and commercial cellular networks, we can reliably perform prehospital neurologic assessments in both rural and urban settings. Further research is needed to establish the reliability and validity of prehospital mobile telestroke assessment in live patients presenting with acute neurologic symptoms.

SUBMITTER: Chapman Smith SN

PROVIDER: S-EPMC4932237 | biostudies-literature | 2016 Jul

REPOSITORIES: biostudies-literature

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Publications

A low-cost, tablet-based option for prehospital neurologic assessment: The iTREAT Study.

Chapman Smith Sherita N SN Govindarajan Prasanthi P Padrick Matthew M MM Lippman Jason M JM McMurry Timothy L TL Resler Brian L BL Keenan Kevin K Gunnell Brian S BS Mehndiratta Prachi P Chee Christina Y CY Cahill Elizabeth A EA Dietiker Cameron C Cattell-Gordon David C DC Smith Wade S WS Perina Debra G DG Solenski Nina J NJ Worrall Bradford B BB Southerland Andrew M AM

Neurology 20160608 1

<h4>Objectives</h4>In this 2-center study, we assessed the technical feasibility and reliability of a low cost, tablet-based mobile telestroke option for ambulance transport and hypothesized that the NIH Stroke Scale (NIHSS) could be performed with similar reliability between remote and bedside examinations.<h4>Methods</h4>We piloted our mobile telemedicine system in 2 geographic regions, central Virginia and the San Francisco Bay Area, utilizing commercial cellular networks for videoconferencin ...[more]

PMID: 27281534

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Project description:BackgroundThere is an extensive library of language tests, each with excellent psychometric properties; however, many of the tests available take considerable administration time, possibly bearing psychological strain on patients. The Short and Tailored Evaluation of Language Ability (STELA) is a simplified, tablet-based language ability assessment system developed to address this issue, with a reduced number of items and automated testing process.ObjectiveThe aim of this paper is to assess the administration time, internal consistency, and validity of the STELA.MethodsThe STELA consists of a tablet app, a microphone, and an input keypad for clinician's use. The system is designed to assess language ability with 52 questions grouped into 2 comprehension modalities (auditory comprehension and reading comprehension) and 3 expression modalities (naming and sentence formation, repetition, and reading aloud). Performance in each modality was scored as the correct answer rate (0-100), and overall performance expressed as the sum of modality scores (out of 500 points).ResultsThe time taken to complete the STELA was significantly less than the time for the WAB (mean 16.2, SD 9.4 vs mean 149.3, SD 64.1 minutes; P<.001). The STELA's total score was strongly correlated with the WAB Aphasia Quotient (r=0.93, P<.001), supporting the former's concurrent validity concerning the WAB, which is a gold-standard aphasia assessment. Strong correlations were also observed at the subscale level; STELA auditory comprehension versus WAB auditory comprehension (r=0.75, P<.001), STELA repetition versus WAB repetition (r=0.96, P<.001), STELA naming and sentence formation versus WAB naming and word finding (r=0.81, P<.001), and the sum of STELA reading comprehension or reading aloud versus WAB reading (r=0.82, P<.001). Cronbach α obtained for each modality was .862 for auditory comprehension, .872 for reading comprehension, .902 for naming and sentence formation, .787 for repetition, and .892 for reading aloud. Global Cronbach α was .961. The average of the values of item-total correlation to each subscale was 0.61 (SD 0.17).ConclusionsOur study confirmed significant time reduction in the assessment of language ability and provided evidence for good internal consistency and validity of the STELA tablet-based aphasia assessment system.

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Dataset Information

A low-cost, tablet-based option for prehospital neurologic assessment: The iTREAT Study.

Objectives

Methods

Results

Conclusions

Publications

A low-cost, tablet-based option for prehospital neurologic assessment: The iTREAT Study.

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