Ilana Spokoyny1, Rema Raman2, Karin Ernstrom3, Bart M Demaerschalk4, Patrick D Lyden5, Thomas M Hemmen6, Amy K Guzik6, James Y Chen7, Brett C Meyer6. 1. Department of Neurosciences, University of California, San Diego, California. Electronic address: ispokoyn@ucsd.edu. 2. Department of Neurosciences, University of California, San Diego, California; Department of Family and Preventative Medicine, University of California, San Diego, California. 3. Department of Family and Preventative Medicine, University of California, San Diego, California. 4. Department of Neurosciences, Mayo Clinic, Phoenix, Arizona. 5. Department of Neurosciences, Cedars Sinai Medical Center, Los Angeles, California. 6. Department of Neurosciences, University of California, San Diego, California. 7. Department of Radiology, University of California, San Diego, California.
Abstract
BACKGROUND AND PURPOSE: The objective of this pooled analysis was to determine the level of agreement between central read and each of 2 groups (spoke radiologists and hub vascular neurologists) in interpreting head computed tomography (CT) scans of stroke patients presenting to telestroke network hospitals. METHODS: The Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC and STRokE DOC-AZ TIME) trials were prospective, randomized, and outcome blinded comparing telemedicine and teleradiology with telephone-only consultations. In each trial, the CT scans of the subjects were interpreted by the hub vascular neurologist in the telemedicine arm and by the spoke radiologist in the telephone arm. We obtained a central read for each CT using adjudicating committees blinded to treatment arm and outcome. The data were pooled and the results reported for the entire population. Kappa statistics and exact agreement rates were used to assess interobserver agreement for radiographic contraindication to recombinant tissue plasminogen activator (rt-PA), presence of hemorrhage, tumor, hyperdense artery, acute stroke, prior stroke, and early ischemic changes. RESULTS: Among 261 analyzed cases, the agreement with central read for the presence of radiological rt-PA contraindication was excellent for hub vascular neurologist (96.2%, κ = .81, 95% CI .64-.97), spoke radiologist report (94.7%, κ = .64, 95% CI .39-.88), and overall (95.4%, κ = .74, 95% CI .59-.88). For rt-PA-treated patients (N = 65), overall agreement was 98.5%, and vascular neurologist agreement with central read was 100%. CONCLUSIONS: Both vascular neurologists and reports from spoke radiologists had excellent reliability in identifying radiologic rt-PA contraindications. These pooled findings demonstrate that telestroke evaluation of head CT scans for acute rt-PA assessments is reliable.
BACKGROUND AND PURPOSE: The objective of this pooled analysis was to determine the level of agreement between central read and each of 2 groups (spoke radiologists and hub vascular neurologists) in interpreting head computed tomography (CT) scans of strokepatients presenting to telestroke network hospitals. METHODS: The Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC and STRokE DOC-AZ TIME) trials were prospective, randomized, and outcome blinded comparing telemedicine and teleradiology with telephone-only consultations. In each trial, the CT scans of the subjects were interpreted by the hub vascular neurologist in the telemedicine arm and by the spoke radiologist in the telephone arm. We obtained a central read for each CT using adjudicating committees blinded to treatment arm and outcome. The data were pooled and the results reported for the entire population. Kappa statistics and exact agreement rates were used to assess interobserver agreement for radiographic contraindication to recombinant tissue plasminogen activator (rt-PA), presence of hemorrhage, tumor, hyperdense artery, acute stroke, prior stroke, and early ischemic changes. RESULTS: Among 261 analyzed cases, the agreement with central read for the presence of radiological rt-PA contraindication was excellent for hub vascular neurologist (96.2%, κ = .81, 95% CI .64-.97), spoke radiologist report (94.7%, κ = .64, 95% CI .39-.88), and overall (95.4%, κ = .74, 95% CI .59-.88). For rt-PA-treated patients (N = 65), overall agreement was 98.5%, and vascular neurologist agreement with central read was 100%. CONCLUSIONS: Both vascular neurologists and reports from spoke radiologists had excellent reliability in identifying radiologic rt-PA contraindications. These pooled findings demonstrate that telestroke evaluation of head CT scans for acute rt-PA assessments is reliable.
Authors: Alan S Go; Dariush Mozaffarian; Véronique L Roger; Emelia J Benjamin; Jarett D Berry; William B Borden; Dawn M Bravata; Shifan Dai; Earl S Ford; Caroline S Fox; Sheila Franco; Heather J Fullerton; Cathleen Gillespie; Susan M Hailpern; John A Heit; Virginia J Howard; Mark D Huffman; Brett M Kissela; Steven J Kittner; Daniel T Lackland; Judith H Lichtman; Lynda D Lisabeth; David Magid; Gregory M Marcus; Ariane Marelli; David B Matchar; Darren K McGuire; Emile R Mohler; Claudia S Moy; Michael E Mussolino; Graham Nichol; Nina P Paynter; Pamela J Schreiner; Paul D Sorlie; Joel Stein; Tanya N Turan; Salim S Virani; Nathan D Wong; Daniel Woo; Melanie B Turner Journal: Circulation Date: 2012-12-12 Impact factor: 29.690
Authors: Bart M Demaerschalk; Bentley J Bobrow; Rema Raman; Karin Ernstrom; Joseph M Hoxworth; Ameet C Patel; Terri-Ellen J Kiernan; Maria I Aguilar; Timothy J Ingall; David W Dodick; Brett C Meyer Journal: Stroke Date: 2012-09-13 Impact factor: 7.914
Authors: B C Meyer; P D Lyden; L Al-Khoury; Y Cheng; R Raman; R Fellman; J Beer; R Rao; J A Zivin Journal: Neurology Date: 2005-03-22 Impact factor: 9.910
Authors: Lee H Schwamm; Eric S Rosenthal; Alan Hirshberg; Pamela W Schaefer; Elizabeth A Little; Joseph C Kvedar; Iva Petkovska; Walter J Koroshetz; Steven R Levine Journal: Acad Emerg Med Date: 2004-11 Impact factor: 3.451
Authors: Shelagh B Coutts; Andrew M Demchuk; Philip A Barber; William Y Hu; Jessica E Simon; Alastair M Buchan; Michael D Hill Journal: Stroke Date: 2004-04-08 Impact factor: 7.914
Authors: Brett C Meyer; Rema Raman; Marcus R Chacon; Matt Jensen; Janet D Werner Journal: J Stroke Cerebrovasc Dis Date: 2008 Jul-Aug Impact factor: 2.136
Authors: Imanuel Dzialowski; Michael D Hill; Shelagh B Coutts; Andrew M Demchuk; David M Kent; Olaf Wunderlich; Rüdiger von Kummer Journal: Stroke Date: 2006-02-23 Impact factor: 7.914
Authors: Rashid L Bashshur; Gary W Shannon; Brian R Smith; Dale C Alverson; Nina Antoniotti; William G Barsan; Noura Bashshur; Edward M Brown; Molly J Coye; Charles R Doarn; Stewart Ferguson; Jim Grigsby; Elizabeth A Krupinski; Joseph C Kvedar; Jonathan Linkous; Ronald C Merrell; Thomas Nesbitt; Ronald Poropatich; Karen S Rheuban; Jay H Sanders; Andrew R Watson; Ronald S Weinstein; Peter Yellowlees Journal: Telemed J E Health Date: 2014-06-26 Impact factor: 3.536
Authors: M R Hov; T Nome; E Zakariassen; D Russell; J Røislien; H M Lossius; C G Lund Journal: Acta Anaesthesiol Scand Date: 2015-05-15 Impact factor: 2.105
Authors: Maren Ranhoff Hov; Erik Zakariassen; Thomas Lindner; Terje Nome; Kristi G Bache; Jo Røislien; Jostein Gleditsch; Volker Solyga; David Russell; Christian G Lund Journal: J Neuroimaging Date: 2017-07-27 Impact factor: 2.486