How a tablet-based system could speed stroke care

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Computer tablets have the potential to speed stroke care while patients are being transported to a hospital by leveraging mobile videoconferencing, according to researchers at the University of Virginia Health System.

The low-cost, tablet-based system enables neurologists to be in the ambulance—virtually via wireless connectivity—to help diagnose patients en route to the hospital, when time is of the essence.

Called the Improving Treatment with Rapid Evaluation of Acute Stroke via Mobile Telemedicine (iTREAT), the system includes an Apple iPad, portable modem/antenna and Cisco Jabber communication app; used together, the components offer an encrypted, HIPAA-compliant video consultation between a neurologist and the stroke patient, as well as with the emergency medical services provider in the vehicle.

Initial feasibility testing of iTREAT found it to be just as accurate as a bedside assessment by a neurologist, enabling paramedics to make more informed medical transport decisions and potentially leading to quicker treatment of the patient when they arrive at the hospital.

Treatments must be administered as soon as possible after the onset of the stroke to maximize the effectiveness of clinician action. Part of the critical medical transport decisions that must be made in the ambulance is whether the patient should be brought to a tertiary center for specialized care or taken to the nearest hospital.

“We’re still in the research phase of testing this system, but the hypothesis is that if we can make the right diagnosis before the patient arrives and take advantage of that precious time, we can potentially prevent disability and even death,” says Andrew Southerland, MD, head of the University of Virginia Health System team that developed the mobile telemedicine system.

His team’s study was conducted in two geographic regions—central Virginia and the San Francisco Bay Area—utilizing commercial cellular networks for videoconferencing transmission. Results of the study, published in the scientific journal Neurology, showed that more than 90 percent of the 27 test ambulance runs conducted in rural and urban environments had sufficient quality and audiovisual connectivity to perform the consultations.

“There were a few runs where the video was either too pixelated or the audio wasn’t good enough,” acknowledges Southerland. “But, for the most part, we were pleasantly surprised by the quality of the connectivity we were able to obtain.”

Overall, researchers determined that stroke testing results were 98 percent correlated with assessments that would have been performed during hospital bedside examinations. The simulated assessments—using patient actors—used the NIH Stroke Scale (NIHSS) to conduct the neurological exams virtually in the ambulances, according to Southerland.

“Utilizing a low-cost, tablet-based platform and commercial cellular networks, we can reliably perform pre-hospital neurologic assessments in both rural and urban settings,” conclude researchers in their article. “Further research is needed to establish the reliability and validity of pre-hospital mobile telestroke assessment in live patients presenting with acute neurologic symptoms.”

Moving forward, Southerland and his team are planning to conduct a trial involving actual stroke patients with results expected next year, with the goal of ultimately putting together a multi-center clinical trial nationally.

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