Clock indicating critical points throughout stroke care may expedite treatment
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Acute stroke management metrics improved with use of an alarm clock in the CT room that indicated several target times up to therapy decision, researchers found.
“We showed that a feedback-demanding alarm clock in the stroke room is a feasible way to improve awareness of the stroke-treating team about the rapidly passing time, thereby reducing delays before treatment,” Klaus Fassbender, MD, professor of neurology at Saarland University Medical Center in Homburg, Germany, told Healio.
Critical times throughout stroke care
For the randomized, prospective, unblinded trial published in Stroke, Mathias Fousse, MD, of the department of neurology at Saarland University Medical Center, and colleagues analyzed data from 107 patients with stroke between February 2016 and November 2017. Patients were assigned to care with a stroke clock (n = 51; median age, 75 years; 55% men) or to a control group (n = 56; median age, 78 years; 55% men).
Patients in the stroke clock group received care by a stroke team in a room equipped with a clock with a large digital display and a buzzer. An alarm demanding active feedback sounded at several times after admission: 15 minutes (end of clinical examination time), 25 minutes (treatment decision time) and 30 minutes (needle time). Visual and auditory alarms activated when time ran out for each target. The team could press a buzzer button before the alarm activated if the task was completed earlier than the given time limit. Patients in the control group received conventional stroke management without assistance from the clock.
The primary endpoint was time to therapy decision. Secondary endpoints included end of point-of-care laboratory, end of neurological examination, end of CTA and end of native CT, in addition to groin puncture time, needle time and achievement of recanalization. Researchers conducted a phone interview at 90 days to assess the modified Rankin Scale score.
The intervention group had significantly better times from door-to-therapy decision compared with the control group (16.73 minutes vs. 26 minutes; P < .001). Other improvements were also observed in this group, including end of neurological examination (7.28 minutes vs. 10 minutes; P < .001), end of CTA (14 minutes vs. 17.17 minutes; P = .001), end of CT (11.17 minutes vs. 14 minutes; P = .002), needle times (18.83 minutes vs. 47 minutes; P = .016) and end of point-of-care laboratory testing (12.14 minutes vs. 20 minutes; P < .001).
Door-to-recanalization time and door-to-groin puncture time seemed to be improved in the stroke clock group vs. the control group, although differences were not statistically significant.
Potential implications
“Use of a simple measure such as a stroke clock can indeed streamline acute stroke management,” Fassbender said in an interview. “With the generally accepted time-is-brain concept, this could have implications for outcomes.”
Fassbender told Healio that it may be simple to implement this kind of strategy in other centers. “It is very easy and inexpensive, but requires some training of the team and some kind of supervision for the adherence to the intervention,” he said.
For more information:
Klaus Fassbender, MD, can be reached at klaus.fassbender@uks.eu.
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