Is There a SPOT for Remote Pediatric Stroke Evaluation in the World of Telestroke Networks? A Pilot Feasibility Study of Performing the Pediatric National Institutes of Health Stroke Scale Over Televideo.

Background: Telestroke assessments are widely used to remotely assess adults with suspected stroke, although they have not been studied in children. SPOT, the Study of Performing the PedNIHSS Over Televideo, tested the feasibility of assessing the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) by televideo in children.

Methods: Children aged 2 to 17 years with and without strokes were recruited and examined in the outpatient neurology clinic. The PedNIHSS was assessed by separate neurologists via televideo and at the bedside. Intraclass correlation coefficients (ICCs) were used to analyze inter-rater reliability.

Results: Twenty children were recruited; mean age was 9.2 years (range, 2 to 17 years). Six had chronic stroke. By bedside examination, the total PedNIHSS score ranged from 0 to 8, with a mean of 1.65. By televideo, the PedNIHSS was identical to the bedside examination in 12 of 20 (60%) of the children and identical or within 1 point in 19 of 20 (95%) with excellent overall inter-rater reliability (ICC = 0.92; 95% confidence interval: 0.81, 0.97). The mean time to complete bedside and remote examinations was 5 and 7 minutes, respectively.

Conclusions: Performing the PedNIHSS over televideo is feasible, accurate, and requires similar time as a bedside evaluation. Limitations of this study include a small sample size and the overall low burden of neurological deficits. Future studies assessing the reliability of performing the PedNIHSS over televideo should include children with acute neurological deficits in the acute care setting across multiple sites.