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doi:10.22028/D291-39811
Title: | Effects of a Feedback-Demanding Stroke Clock on Acute Stroke Management: A Randomized Study |
Author(s): | Fousse, Mathias Grün, Daniel Helwig, Stefan A Walter, Silke Bekhit, Adam Wagenpfeil, Stefan Lesmeister, Martin Kettner, Michael Roumia, Safwan Mühl-Benninghaus, Ruben Simgen, Andreas Yilmaz, Umut Ruckes, Christian Kronfeld, Kai Bachhuber, Monika Grunwald, Iris Q Bertsch, Thomas Reith, Wolfgang Faßbender, Klaus |
Language: | English |
Title: | Stroke |
Volume: | 51 |
Issue: | 10 |
Pages: | 2895-2900 |
Publisher/Platform: | Lippincott Williams & Wilkins |
Year of Publication: | 2020 |
Free key words: | acute management stroke thrombectomy thrombolysis |
DDC notations: | 610 Medicine and health |
Publikation type: | Journal Article |
Abstract: | Background and Purpose: This randomized study aimed to evaluate whether the use of a stroke clock demanding active feedback from the stroke physician accelerates acute stroke management. Methods: For this randomized controlled study, a large-display alarm clock was installed in the computed tomography room, where admission, diagnostic work-up, and intravenous thrombolysis occurred. Alarms were set at the following target times after admission: (1) 15 minutes (neurological examination completed); (2) 25 minutes (computed tomography scanning and international normalized ratio determination by point-of-care laboratory completed); and (3) 30 minutes (intravenous thrombolysis started). The responsible stroke physician had to actively provide feedback by pressing a buzzer button. The alarm could be avoided by pressing the button before time out. Times to therapy decision (primary end point, defined as the end of all diagnostic work-up required for decision for or against recanalizing treatment), neurological examination, imaging, point-of-care laboratory, needle, and groin puncture were assessed by a neutral observer. Functional outcome (modified Rankin Scale) was assessed at day 90. Results: Of 107 participants, 51 stroke clock patients exhibited better stroke-management metrics than 56 control patients. Times from door to (1) end of all indicated diagnostic work-up (treatment decision time; 16.73 versus 26.00 minutes, P<0.001), (2) end of neurological examination (7.28 versus 10.00 minutes, P<0.001), (3) end of computed tomography (11.17 versus 14.00 minutes, P=0.002), (4) end of computed tomography angiography (14.00 versus 17.17 minutes, P=0.001), (5) end of point-of-care laboratory testing (12.14 versus 20.00 minutes, P<0.001), and (6) needle times (18.83 versus 47.00 minutes, P=0.016) were improved. In contrast, door-to-groin puncture times and functional outcomes at day 90 were not significantly different. Conclusions: This study showed that the use of a stroke clock demanding active feedback significantly improves acute stroke-management metrics and, thus, represents a potential low-cost strategy for streamlining time-sensitive stroke treatment. |
DOI of the first publication: | 10.1161/STROKEAHA.120.029222 |
URL of the first publication: | https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.120.029222 |
Link to this record: | urn:nbn:de:bsz:291--ds-398113 hdl:20.500.11880/35865 http://dx.doi.org/10.22028/D291-39811 |
ISSN: | 0039-2499 1524-4628 |
Date of registration: | 22-May-2023 |
Faculty: | M - Medizinische Fakultät |
Department: | M - Medizinische Biometrie, Epidemiologie und medizinische Informatik M - Radiologie |
Professorship: | M - Prof. Dr. Wolfgang Reith M - Prof. Dr. Stefan Wagenpfeil |
Collections: | SciDok - Der Wissenschaftsserver der Universität des Saarlandes |
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