Abstract
Background and purpose: There are clear differences in the outcome between regions with respect to the rate of thrombolytic use for acute ischemic stroke. On the basis of this assumption, Telestroke has been proposed as a specialized remote treatment technology for stroke. We put together a single-hub single-spoke network and investigated the concordance rate for remote evaluation of neurological findings as well as technical issues, such as time required for evaluation and envisaging the use of tissue plasminogen activator (tPA) injection therapy.Methods: We calculated the National Institutes of Health Stroke Scale (NIHSS) scores for 15 healthy individuals simultaneously by remote examination and face-to-face examination and evaluated the time required for measurements. Next, we calculated the NIHSS scores for 15 subacute stroke patients simultaneously by remote examination and face-to-face examination, and evaluated the measurement errors and concordance rate. We also investigated camera positioning and time taken to establish communication for patients within 3 h of onset.Results: Time required for NIHSS score measurements was significantly longer by using Telestroke, at an average of 2 min 41 s. The average error in the scores was only 0.73 points, but the occurrence of errors was possible especially with patients who had difficulty in understanding the instructions required for examination because of aphasia. For score measurements, the camera should be placed 150-170 cm directly above the subjects' head, and the appropriate time to start remote examination support is by establishing communication after computed tomography (CT) scanning. Conclusions: tPA injection by remote medical support using an interactive videoconferencing system is feasible.
