Unassisted assessment of stroke severity using telemedicineUnassisted assessment of stroke severity using telemedicine
Faculty of Medicine and Health Sciences
Faculty of Pharmaceutical, Biomedical and Veterinary Sciences . Biomedical Sciences
Neurochemistry and behaviour
2013New York, N.Y., 2013
Stroke: a journal of cerebral circulation / American Heart Association. - New York, N.Y.
44(2013):5, p. 1249-+
University of Antwerp
Background and PurposeQuantification of stroke severity through telemedicine consultation is challenging and relies on professional support at the patients bedside. We aimed to develop a novel scale for assessing stroke severity through telemedicine without assistance from a third party (Unassisted TeleStroke Scale [UTSS]). MethodsStroke severity was assessed in 45 patients with suspicion of acute stroke by bedside examination using the National Institutes of Health Stroke Scale (NIHSS) and by teleconsultation using the UTSS. Scale reliability was evaluated by intrarater and interrater variability, internal consistency, and rater agreement. Concurrent and predictive validity weretested by relating the UTSS with the NIHSS and long-term outcome (modified Rankin Scale and mortality at 6 months).Clinimetric analysis of the UTSS was obtained via the Rasch model. ResultsThe mean examination time for the UTSS was 3.1 minutes (SD, 1.1) versus 8.5 minutes for the NIHSS (SD, 2.6; P<0.001). Both UTSS and NIHSS showed excellent intrarater variability (r=0.97 and 0.98; P<0.001) and interrater variability (r=0.96 and 0.98; P<0.001), as well as excellent internal consistency and rater agreement. The UTSS correlated strongly with the NIHSS and was identified as an independent predictor of stroke outcome in logistic regression analysis. Rasch analysis indicated that the UTSS represents a unidimensional scale of stroke severity. ConclusionsThe UTSS is a rapid, reliable, and valid tool for unassisted assessment of stroke severity through telemedicine.