Reliability of the Telemedicine Examination in the Neurologic Diagnosis of Death

Teleneurology and Artificial Intelligence in Clinical Practice

ABSTRACT

As teleheath becomes integrated into the practice of medicine, it is important to understand the benefits, limitations, and variety of applications. Telestroke was an early example of teleneurology that arose from a need for urgent access to neurologists for time-sensitive treatments for stroke. It made a scarce resource widely available via video conferencing technologies. Additionally, applications such as outpatient video visits, electronic consultation (e-consult), and wearable devices developed in neurology, as well. Telehealth dramatically increased during the COVID-19 pandemic when offices were closed and hospitals were overwhelmed; a multitude of both outpatient and inpatient programs developed and matured during this time. It is helpful to explore what has been learned regarding the quality of telehealth, disparities in care, and how artificial intelligence can interact with medical practices in the teleneurology context.

Telemedicine in civil protection: A controlled simulation study for the analysis of patient care

Objectives

More and more disasters are occurring and there will be an increasing shortage of physicians in the future. Telemedicine could be a solution here to offer medical care despite the lack of physicians in the area of operation. This study analyzes whether telemedicine for lower-qualified paramedics is comparable to conventional disaster medicine.

Methods

A simulation study was conducted in which one conventional and two telemedicine groups cared for thermal-traumatically injured in a stressful situation. The telemedicine was conducted on tablets with integrated vital sign monitoring or on smartphones. The physician engagement time, the number of physician contacts, the time for relevant measures and the usage behavior of telemedicine were examined between these groups.

Results

One telemedicine group showed significantly fewer patient contacts. This can be attributed to the ongoing consultation in the intervention group with more contacts. There are no significant differences in the relevant measures.

Conclusion

Telemedicine is comparable to conventional disaster medicine in civil protection. Due to potential technical failures, it should primarily be used to compensate for the lack of physicians, and training should focus on an exit-strategy in case of a failure of the telemedicine.

Demonstration of High Diagnostic Accuracy for Cerebral Ischemia in a Large Academic Hub-and -Spoke Telestroke Network

Objective

To determine the diagnostic accuracy of the initial telestroke consultation in a large academic hub-and-spoke telemedicine network.

Patients and Methods

This retrospective study includes all patients evaluated for cerebral ischemia through video telestroke consultation in a large academic hub-and-spoke telemedicine network from January 1, 2019 to December 31, 2020. A detailed chart review was conducted to identify the initial suspected diagnosis and final diagnosis. Cerebral ischemia was defined as acute ischemic stroke and transient ischemic attack. All other diagnoses were defined as stroke mimics. Data were organized into continuous and categorical variables. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, area under the curve (AUC), and likelihood ratio (LR+) for the telestroke-consultation diagnosis were calculated while using the final diagnosis as the gold standard diagnosis.

Results

A total of 1043 patients met the inclusion criteria. The final diagnosis of cerebral ischemia was made in 63.5% of all patients (539 of the 1043 with acute ischemic stroke,123 of the 1043 with transient ischemic attack). Stroke mimic was diagnosed in 36.5% patients (381 of the 1043). The sensitivity and specificity of telestroke evaluation for diagnosis of cerebral ischemia were 97.1% and 81.4%, respectively. Positive predictive value was 90.1%, and negative predictive value was 94.2%. Overall diagnostic accuracy was 91.4%, with an LR+ of 5.21 and AUC of 0.89.

Conclusion

This study highlights the high diagnostic accuracy of telestroke providers in diagnosing cerebral ischemia. Further research exploring the application of teleneurology in the nonstroke setting and other medical subspecialties is warranted.

Telemedicine in Neurosurgery: Standardizing the Spinal Physical Examination Using A Modified Delphi Method

Objective

The use of telemedicine has dramatically increased due to the coronavirus disease 2019 pandemic. Many neurosurgeons are now using telemedicine technologies for preoperative evaluations and routine outpatient visits. Our goal was to standardize the telemedicine motor neurologic examination, summarize the evidence surrounding clinical use of telehealth technologies, and discuss financial and legal considerations.

Methods

We identified a 12-member panel composed of spine surgeons, fellows, and senior residents at a single institution. We created an initial telehealth strength examination protocol based on published data and developed 10 agree/disagree statements summarizing the protocol. A blinded Delphi method was utilized to build consensus for each statement, defined as > 80% agreement and no significant disagreement using a 2-way binomial test (significance threshold of p < 0.05). Any statement that did not meet consensus was edited and iteratively resubmitted to the panel until consensus was achieved. In the final round, the panel was unblinded and the protocol was finalized.

Results

After the first round, 4/10 statements failed to meet consensus (< 80% agreement, and p = 0.031, p = 0.031, p = 0.003, and p = 0.031 statistical disagreement, respectively). The disagreement pertained to grading of strength of the upper (3/10 statements) and lower extremities (1/10 statement). The amended statements clarified strength grading, achieved consensus (> 80% agreement, p > 0.05 disagreement), and were used to create the final telehealth strength examination protocol.

Conclusion

The resulting protocol was used in our clinic to standardize the telehealth strength examination. This protocol, as well as our summary of telehealth clinical practice, should aid neurosurgical clinics in integrating telemedicine modalities into their practice.