Stroke Journal Report
09/19/2003

Personal computers bring high-tech stroke evaluation to rural areas

DALLAS, Sept. 19 – Armed with a personal computer and a telephone, specialists can accurately assess brain damage in stroke patients in rural areas miles away, scientists report in today’s rapid access issue of Stroke: Journal of the American Heart Association.

“This is a first step in bringing state-of-the-art neurological care to rural stroke patients who would otherwise have no access to specialist care,” said study author Sam Wang, M.S., a research scientist in the neurology department at the Medical College of Georgia in Augusta.

Researchers hope to increase the number of rural patients treated with the clot-busting drug tissue plasminogen activator (tPA), the only approved medication for ischemic stroke.  The drug must be delivered within three hours of symptom onset.  Fewer than five percent of eligible patients receive it.

“Treatment with tPA in rural Georgia is virtually nonexistent because there are few neurologists in rural hospitals,” he said. 

Georgia researchers devised the Remote Evaluation of Acute Ischemic Stroke (REACH) initiative to provide stroke expertise to remote locales in a timely manner via telemedicine.   The first step was to determine if remote specialists could assess neurological damage using the National Institutes of Health Stroke Scale (NIHSS).  The NIHSS assesses motor, sensory, and visual impairments, on a scale of 0-42 through a physical exam and a series of questions.

Other studies have shown that NIHSS is reliable when used over interactive video, but required costly videoconferencing equipment and dedicated bandwidth. 

“The REACH initiative more closely mimics real-life conditions, working over any broadband-connected office or home personal computer,” he said.

Researchers studied 20 patients suffering from stroke.  An on-site neurologist performed a bedside NIHSS evaluation on each patient. Within one hour, an onsite assistant wheeled the camera-equipped REACH cart to the patient’s bedside and entered their vital signs.  Then a second neurologist logged in from a remote location and conducted the NIHSS evaluation.

There was no instance in which the scores determined by an onsite neurologist and a remote neurologist differed by more than 3 points.

In an accompanying editorial, Olaf Crome, M.D., and Mathias Bahr, M.D., of the department of neurology at University Hospital Gottingen in Gottingen, Germany, said the small study shows that such an approach may work.  Nevertheless, having more tertiary stroke centers in outlying areas may be a better strategy, because there are other steps in stroke evaluation.

But Wang noted that many rural patients will still have to be transported by helicopter. “And our electrons move faster than any ‘chopper’,” he said.

Co-authors are Sung Bae Lee, M.D.; Carol Pardue, M.S.N.; Davinder Ramsingh, B.S.; Jennifer Waller, Ph.D.; Hartmut Gross, M.D.; Fenwick T. Nichols III, M.D.; David C. Hess, M.D.; and Robert J. Adams, M.D.

Editor’s note: For more information on stroke, visit the American Stroke Association Web site.

NR03-1132b (Stroke/Wang)

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