Introduction: While there are several studies on reliability of telemedicine in assessing stroke scales, little is known about the validity of a general neurological examination performed via telemedicine. Therefore, we sought to test the agreement between bedside and remote examination in acute patients of the emergency room. Methods: Acute patients at the emergency room of a 450-bed academic teaching hospital were included in this study. A clinical neurological examination consisting of 22 items was performed at bedside and also remotely via an audio-visual link by a different neurologist; both were experienced clinicians at the consultant level. Kappa statistics were calculated for each item of the examination. Results: Forty three patients completed both examinations (mean age 58.3 years, 56% female). Patients were seen between 8 and 72 min after admission (mean 36.3 min). Total time for remote examination was 12.6 min (8–21 min) and 8.9 min (5–18 min) for bedside examination. K-coefficients ranged from 0.32 (muscle tone) – 0.82 (language) indicating a fair to excellent agreement in most items. Conclusions: Remote examination via an audio-visual link produces comparable results to bedside performance even in acute patients of the emergency room. Compared to the scarce data available, inter-observer agreement is about the same as that between 2 examiners at bedside. However, more studies on reliability and validity of clinical neurological examination are required.

Hubble JP, Pahwa R, Michalek DK, Thomas C, Koller WC. Interactive video conferencing: a means of providing interim care to Parkinson’s disease patients.
Mov Disord
. 1993 Jul; 8(3): 380–2.
Rasmusson KA, Hartshorn JC. A comparison of epilepsy patients in a traditional ambulatory clinic and a telemedicine clinic.
. 2005 May; 46(5): 767–70.
Handschu R, Littmann R, Reulbach U, Gaul C, Heckmann JG, Neundörfer B, et al. Telemedicine in emergency evaluation of acute stroke: interrater agreement in remote video examination with a novel multimedia system.
. 2003 Dec; 34(12): 2842–6.
Alasheev AM, Andreev AY, Gonysheva YV, Lagutenko MN, Lutskovich OY, Mamonova AV, et al. A Comparison of Remote and Bedside Assessment of the National Institute of Health Stroke Scale in Acute Stroke Patients.
Eur Neurol
. 2017; 77(5-6): 267–71.
Audebert HJ, Schenkel J, Heuschmann PU, Bogdahn U, Haberl RL; Telemedic Pilot Project for Integrative Stroke Care Group. Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany.
Lancet Neurol
. 2006 Sep; 5(9): 742–8.
Handschu R, Wacker A, Scibor M, Sancu C, Schwab S, Erbguth F, et al. Use of a telestroke service for evaluation of non-stroke neurological cases.
J Neurol
. 2015 May; 262(5): 1266–70.
Chua R, Craig J, Wootton R, Patterson V. Randomised controlled trial of telemedicine for new neurological outpatient referrals.
J Neurol Neurosurg Psychiatry
. 2001 Jul; 71(1): 63–6.
Wechsler LR, Tsao JW, Levine SR, Swain-Eng RJ, Adams RJ, Demaerschalk BM, et al.; American Academy of Neurology Telemedicine Work Group. Teleneurology applications: Report of the Telemedicine Work Group of the American Academy of Neurology.
. 2013 Feb; 80(7): 670–6.
Rubin MN, Wellik KE, Channer DD, Demaerschalk BM. Systematic review of teleneurology: neurohospitalist neurology.
. 2013 Jul; 3(3): 120–4.
Craig J, Patterson V, Russell C, Wootton R. Interactive videoconsultation is a feasible method for neurological in-patient assessment.
Eur J Neurol
. 2000 Nov; 7(6): 699–702.
Craig J, Chua R, Russell C, Wootton R, Chant D, Patterson V. A cohort study of early neurological consultation by telemedicine on the care of neurological inpatients.
J Neurol Neurosurg Psychiatry
. 2004 Jul; 75(7): 1031–5.
Craig JJ, McConville JP, Patterson VH, Wootton R. Neurological examination is possible using telemedicine.
J Telemed Telecare
. 1999; 5(3): 177–81.
Handschu R, Scibor M, Wacker A, Stark DR, Köhrmann M, Erbguth F, et al. Feasibility of certified quality management in a comprehensive stroke care network using telemedicine: STENO project.
Int J Stroke
. 2014 Dec; 9(8): 1011–6.
Janssen F, Awadallah M, Alhalabi A, Körber B, Lang R, Scibor M, et al. Telemedicine in general neurology: use of audiovisual consultation for on call back-up service in an acute care hospital.
J Neurol
. 2018 Apr; 265(4): 880–4.
Gelb DJ, Gunderson CH, Henry KA, Kirshner HS, Józefowicz RF; Consortium of Neurology Clerkship Directors and the Undergraduate Education Subcommittee of the American Academy of Neurology. The neurology clerkship core curriculum.
. 2002 Mar; 58(6): 849–52.
Hallett M. NINDS myotatic reflex scale.
. 1993 Dec; 43(12): 2723.
Thaller M, Hughes T. Inter-rater agreement of observable and elicitable neurological signs.
Clin Med (Lond)
. 2014 Jun; 14(3): 264–7.
Hand PJ, Haisma JA, Kwan J, Lindley RI, Lamont B, Dennis MS, et al. Interobserver agreement for the bedside clinical assessment of suspected stroke.
. 2006 Mar; 37(3): 776–80.
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