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Remote assessment of stroke using the iPhone 4.

Eric R Anderson1, Bryan Smith, Moges Ido

  • 1Department of Neurology, Emory University, Atlanta, Georgia 30033, USA. eric.anderson@emory.edu

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|October 25, 2011
PubMed
Summary

An iPhone 4 can effectively assess ischemic stroke patients remotely, improving access to care in rural hospitals lacking stroke expertise. This economical mobile solution offers high-fidelity telestroke management.

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Area of Science:

  • Neurology
  • Medical Technology
  • Telemedicine

Background:

  • Recombinant tissue plasminogen activator therapy for ischemic stroke is underutilized in rural hospitals due to limited stroke expertise.
  • Telemedicine is recommended for stroke management when vascular neurologists are unavailable, but current solutions are costly.
  • Existing telemedicine systems present significant financial barriers for underserved rural healthcare facilities.

Purpose of the Study:

  • To evaluate the efficacy of using the iPhone 4 as an economical tool for remote telestroke assessment.
  • To determine the reliability of remote stroke patient evaluations using mobile technology.

Main Methods:

  • Twenty stroke patients were assessed at the bedside using an iPhone 4, with remote guidance via another iPhone 4.

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  • Physicians performing bedside and remote exams independently calculated National Institutes of Health Stroke Scale (NIHSS) scores, blinded to each other's results.
  • Interrater reliability was assessed using the κ statistic for individual NIHSS items and the intraclass correlation coefficient for total scores.
  • Main Results:

    • Excellent agreement was found for 10 NIHSS items, moderate agreement for 3 items, and poor agreement for 1 item.
    • Total NIHSS scores obtained remotely and at the bedside demonstrated excellent agreement (intraclass correlation coefficient = 0.98).
    • The iPhone 4 proved to be an economical mobile solution for remote stroke patient assessment.

    Conclusions:

    • The iPhone 4 is a viable, cost-effective mobile solution for remote telestroke management.
    • This technology can be integrated into telestroke networks to improve stroke care accessibility in rural areas.
    • High-fidelity remote assessment of stroke patients is achievable using readily available mobile devices.