Abstract T MP49: Pre-Hospital Utility of Rapid Stroke Evaluation Using In-Ambulance Telemedicine (PURSUIT): A Pilot Feasibility Study

Objective: Pre-hospital evaluation using audio/video telemedicine (TM) might accelerate acute stroke treatment with t-PA. We explored the reliability and feasibility of using TM via a mobile device in ambulances to help identify and evaluate acute stroke patients. Methods: Ten unique, scripted stroke scenarios with various levels of stroke severity were portrayed by trained actors retrieved and transported by EMS to our stroke center. Each scenario was conducted 4 times, for a total of 40 scenarios. Each scenario began when EMS arrived on scene and a vascular neurologist (VN) simultaneously logged on to the TM device remotely, and ended once the ambulance arrived at the emergency department. The VNs performed assessments in real-time, obtaining clinical data points and NIHSS using the In-Touch RP-Xpress TM device with Verizon 4G wireless connectivity. Each scenario was recorded for a subsequent evaluation by a second blinded VN. Study feasibility was defined by the ability to conduct 80% of the sessions without major technological limitations. Reliability was defined by a 90% concordance between the data derived during the live/recorded sessions and the scripted scenarios; intra-class correlation (ICC) for NIHSS gathered during the live and recorded sessions was calculated. Audio/video quality and stability of connection were graded by paramedics and VNs for the live sessions on a scale of 1 to 5 (1=Poor; 2= Fair; 3= Good; 4= Very Good; 5=Excellent). Results: In 34 of 40 (85%) scenarios, the tele-consultation was conducted without major technical complication. The absolute agreement for ICC using the two-way mixed-effects model was 0.991 (95% CI 0.97-0.998) for the NIHSS obtained during the live sessions and 0.97 (95% CI 0.91-0.997) for the recorded sessions. Of the 34 live assessments, 30 (91%) matched the NIHSS by ±2 points, and 96% of the clinical information obtained by the remote neurologist matched those provided from the script. Audio/video quality and stability of connection were rated from good to very good by the EMS and VNs Conclusion: Mobile TM is reliable and feasible in assessing actors simulating acute stroke in the pre-hospital setting.