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Reliability of Prehospital Real-Time Cellular Video Phone in Assessing the Simplified National Institutes of Health Stroke Scale in Patients With Acute Stroke: A Novel Telemedicine Technology

Background and Purpose— The National Institutes of Health Stroke Scale (NIHSS) is the gold standard to assess patients with acute stroke. We aimed to examine the feasibility and reliability of prehospital real-time cellular video phone (VP) in performing the NIHSS. Methods— Forty physicians prospectively performed a simplified NIHSS (sNIHSS) on a standardized patient remotely using VP with the assistance of a bedside emergency medical technician and later performed a bedside examination. We tested the hypothesis that there is high reliability between these 2 methods. Physicians were timed and sNIHSS scores were recorded. Finally, physicians were asked to rate the VP technology. Results— A total of 480 pair comparisons of the sNIHSS scores between the VP and bedside examination were generated. After adjusting for the physician's specialty, level of training, and certification status, there was a strong positive linear correlation (r=0.97, P<0.01) between the 2 methods with high average physician reliability (0.99; 95% CI, 0.992 to 0.995). The mean sNIHSS scores using VP and bedside examination were not different (6.82±1.06 versus 6.63±0.98; P=0.08). The mean time to perform the sNIHSS using VP was approximately 38 seconds longer than the bedside examination (3.38±0.77 versus 2.93±0.83 minutes; P=0.006). Conclusions— The VP is a feasible, reliable, and timely tool with the potential for remotely assessing the sNIHSS for patients presenting with acute stroke and may expedite the initial evaluation and treatment strategies.