- 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
- Treatment success is time sensitive, with every 30-minute delay associated with ~15% deterioration in outcome.
- 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).
- 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).
- 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.
- Lack of blinding.
- Intervention not tested 24/7.
- Uncertain generalizability.