Editorial Comment Remote Evaluation of Acute Ischemic Stroke : A Reliable Tool to Extend Tissue Plasminogen Activator Use to Community and Rural Stroke Patients ?

Background and Purpose—Despite Food and Drug Administration approval of tissue-type plasminogen activator for stroke, obstacles in the US healthcare system prevent its widespread use. The Remote Evaluation for Acute Ischemic Stroke (REACH) program was developed to address these issues in rural settings. A key component of stroke assessment in the REACH system is the National Institutes of Health Stroke Scale (NIHSS) evaluation. We sought to determine whether, using the REACH system, NIHSS values of bedside and remote evaluators would correspond. Methods—Twenty patients were recruited. On obtaining consent, a neurologist performed a bedside NIHSS evaluation on each patient. Within 1 hour, using any broadband-connected workstation—either office or home personal computer and a landline phone to speak with the patient—a second neurologist remotely evaluated the patient through the REACH system. Paired t tests and Pearson correlation coefficients were used to examine NIHSS reliability performed bedside and remotely. Results—NIHSS ranged from 1 to 24. Correlations between bedside and remote locations (r 0.9552, P 0.0001) were very strong, and t tests indicate that the means were not different. Conclusions—The NIHSS can be reliably performed over the REACH system. This supports our endeavor to bring stroke expertise to rural community hospitals. (Stroke. 2003;34:e188-e192.)