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Smartphone Application in Evaluation and Treatment of Acute Stroke
Study Questions:
Does a smartphone application that shares clinical and imaging data result in appropriate decision-making and decreased door-to-needle (DTN) times in the management of acute ischemic stroke patients?
Methods:
This is a study of all patients for whom an acute stroke code was activated at one academic hospital in Brazil over 1 year. The intervention was adoption of a smartphone application which included a chat function, time stamp function, and shared image viewing. All neurology residents and stroke attendings had access to this app. The primary outcome was the rate of agreement between the app-supported treatment decision and the treatment decision later recommended by an expert panel of stroke neurologists (unblinded) and neuroradiologists (blinded) for patients considered for thrombolysis. The secondary outcomes included the difference in the median DTN times between the 12 months of the study period and the 12 months immediately preceding the study period (pre-/post-design).
Results:
An acute stroke activation occurred for 720 patients. Of these, 442 patients met study inclusion criteria (acute ischemic stroke assessed using the smartphone app). For the primary outcome of patients considered for thrombolysis, in only 1/147 (0.7%) did the expert panel disagree with the decision that had been made in real-time supported by the app. The median DTN time improved from 90 minutes (interquartile range [IQR], 75-106) in the period prior to use of the app to 63 minutes (IQR, 61-117) after (p = 0.03).
Conclusions:
The adoption of a smartphone application with chatting and image sharing functionality by the neurology residents and stroke attendings at a single Brazilian academic center seemed to support appropriate acute treatment decision-making and resulted in improvement in this center’s median DTN time.
Perspective:
This study reports on what was essentially a quality improvement initiative at a single academic hospital. This hospital’s emergency room is staffed 24/7/365 by neurology residents, limiting the generalizability of the results of this study to centers where emergent neurologic evaluation is not always available. The main benefit of the smartphone app was in obviating the stroke attendings’ need to drive to the hospital to evaluate images on the Picture Archiving and Communication System (PACS), thereby leading to shorter DTN times. For hospitals where stroke attendings already have access to patient images on their home/personal devices, this app is unlikely to result in shorter DTN times.
Clinical Topics: Cardiovascular Care Team, Noninvasive Imaging, Prevention
Keywords: Brain Ischemia, Cell Phone, Decision Making, Diagnostic Imaging, Medical Informatics Applications, Mobile Applications, Neurology, Quality Improvement, Radiology Information Systems, Secondary Prevention, Stroke, Telemedicine, Thrombolytic Therapy, Vascular Diseases
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