Stroke alarm clock that requires feedback expedites care

  • Stroke

  • Susan London
  • Clinical Essentials
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Takeaway

  • Use of a stroke alarm clock requiring active feedback hastens diagnostic work-up and start of thrombolysis, although functional outcome is not significantly improved.

Why this matters

Key results

  • Compared with usual care, the stroke clock shortened times from admission (door) to:
    • Treatment decision: 16.73 vs 26.00 minutes (P<.001>
    • End of neurologic examination: 7.28 vs 10.00 minutes (P<.001>
    • End of CT imaging: 11.17 vs 14.00 minutes (P=.002).
    • End of CT angiography: 14.00 vs 17.17 minutes (P=.001).
    • End of point-of-care laboratory testing: 12.14 vs 20.00 minutes (P<.001>
    • Intravenous thrombolysis needle placement: 18.83 vs 47.00 minutes (P=.016).
  • Groups similar on:
    • Door-to-groin puncture time: 68.10 vs 78.75 minutes (P=.262).
    • Day 90 favorable functional outcome (modified Rankin Scale 0-2): 58.8% vs 48.2% (P=.333).

Study design

  • German single-center randomized controlled trial: 107 patients, symptoms ≤8 hours duration or wake-up stroke.
  • Randomization: usual care vs stroke clock (large-display clock in CT room, alarms set for targets; physician required to press buzzer button).
  • Main outcome: time to treatment decision (end of diagnostic work-up required for decision about recanalization).
  • Funding: Ministry of Health of the Saarland.

Limitations

  • Lack of blinding.
  • Intervention not tested 24/7.
  • Uncertain generalizability.