Reliability of Robotic Telemedicine for Assessing Critically Ill Patients with the Full Outline of UnResponsiveness Score and Glasgow Coma Scale

Abstract

PURPOSE: Telemedicine is increasingly utilized in the evaluation of critically ill patients, including those with decreased level of consciousness (LOC) or coma. Improving access to providers with neurologic expertise affords earlier triage and directed patient management. However, objective data regarding the reliability of using standardized coma scales, traditionally employed at the bedside for remote assessment, are largely lacking. HYPOTHESIS: Bedside and remote assessments of patients with decreased LOC, using either the Glasgow Coma Scale (GCS) or Full scale Of UnResponsiveness (FOUR), score are equivalent. METHODS: Prospective trial comparing the reliability of bedside and remote coma assessments using GCS or FOUR score clinical evaluation tools utilizing robotic telepresence technology. Total scores of the GCS and FOUR score were compared between bedside and remote physician assessors by paired t-test and Pearson correlation coefficient (PCC). RESULTS: One hundred subjects were enrolled. Mean age was 70.8 (±15.9) years and the average examination time took 5.16 (±2.04) minutes. Mean GCS total score at bedside was 7.5 (±3.67) versus examination conducted remotely 7.23 (±3.85); difference in scores was 0.25 (±0.10); p = 0.01. Mean FOUR total score at bedside was 9.63 (±4.76) versus remote 9.21 (±4.74); difference in scores was 0.40 (±2.00); p = 0.05. PCC for GCS was 0.966; p < 0.001, and for FOUR score 0.912; p < 0.001. Ninety-five percent of remote providers rated GCS and 89% rated FOUR score as good (4/5) regarding overall satisfaction and ease of use. CONCLUSIONS: Differences between total bedside and remote GCS and FOUR scores were small. Furthermore, PCCs between remote and bedside assessments were excellent: 0.97 (GCS) and 0.91 (FOUR). These results suggest that LOC can be reliably assessed using existing robotic telemedicine technology. Telemedicine could be adopted to help evaluate critically ill patients in neurologically underserved areas.