Freeman, William D

AbstractBackgroundThe primary aim of this study was to determine the safety and feasibility of capturing and streaming neuronavigation images onto a head‐up display during spine instrumentation.MethodsUsing a novel device, neuronavigation images were captured and transferred wirelessly via a password‐encrypted network to the head‐up display. At the end of the procedure, the surgeons completed a survey to gather their opinions of the system.ResultsForty pedicle screws were placed using the head‐up display. The average screw placement time was slightly shorter when the head‐up display was used (4.13 min with vs. 4.86 min without). The post‐procedure survey demonstrated that 79% of surgeon's responses were positive.ConclusionA wearable head‐up display can benefit current neuronavigation systems, but larger, outcomes‐based trials are needed. Higher processing speed would allow streaming of higher resolution images. Along with an enlarged display, these may significantly improve utilization of this technology. Copyright © 2016 John Wiley & Sons, Ltd.

Background Ischemic stroke is a time-sensitive disease, with improved outcomes associated with decreased time from onset to treatment. It was hypothesised that ambulance-based assessment of the National Institutes of Health Stroke Scale (NIHSS) using a Health Insurance Portability and Accountability Act (HIPAA)–compliant mobile platform immediately prior to arrival is feasible. Methods This is a proof-of-concept feasibility pilot study in two phases. The first phase consisted of an ambulance-equipped HIPAA-compliant video platform for remote NIHSS assessment of a simulated stroke patient. The second phase consisted of remote NIHSS assessment by a hospital-based neurologist of acute stroke patients en route to our facility. Five ambulances were equipped with a 4G/LTE-enabled tablet preloaded with a secure HIPAA-compliant telemedicine application. Secondary outcomes assessed satisfaction of staff with the remote platform. Results Phase one was successful in the assessment of three out of three simulated patients. Phase two was successful in the assessment of 10 out of 11 (91%) cases. One video attempt was unsuccessful because local LTE was turned off on the device. The video signal was dropped transiently due to weather, which delayed NIHSS assessment in one case. Average NIHSS assessment time was 7.6 minutes (range 3–9.8 minutes). Neurologists rated 83% of encounters as ‘satisfied’ to ‘very satisfied’, and the emergency medical service (EMS) rated 90% of encounters as ‘satisfied’ to ‘very satisfied’. The one failed video attempt was associated with ‘poor’ EMS satisfaction. Conclusion This proof-of-concept pilot demonstrates that remote ambulance-based NIHSS assessment is feasible. This model could reduce door-to-needle times by conducting prehospital data collection.