Alotaibi Naif M, Sarzetto Francesca, Guha Daipayan, Lu Michael, Bodo Andre, Gupta Shaurya, Dyer Erin, Howard Peter, da Costa Leodante, Swartz Richard H, Boyle Karl, Nathens Avery B, Yang Victor X D
Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
World Neurosurg. 2017 Nov;107:678-683. doi: 10.1016/j.wneu.2017.08.042. Epub 2017 Aug 18.
The metrics of imaging-to-puncture and imaging-to-reperfusion were recently found to be associated with the clinical outcomes of endovascular thrombectomy for acute ischemic stroke. However, measures for improving workflow within hospitals to achieve better timing results are largely unexplored for endovascular therapy. The aim of this study was to examine our experience with a novel smartphone application developed in house to improve our timing metrics for endovascular treatment.
We developed an encrypted smartphone application connecting all stroke team members to expedite conversations and to provide synchronized real-time updates on the time window from stroke onset to imaging and to puncture. The effects of the application on the timing of endovascular therapy were evaluated with a secondary analysis of our single-center cohort. Our primary outcome was imaging-to-puncture time. We assessed the outcomes with nonparametric tests of statistical significance.
Forty-five patients met our criteria for analysis among 66 consecutive patients with acute ischemic stroke who received endovascular therapy at our institution. After the implementation of the smartphone application, imaging-to-puncture time was significantly reduced (preapplication median time, 127 minutes; postapplication time, 69 minutes; P < 0.001). Puncture-to-reperfusion time was not affected by the application use (42 minutes vs. 36 minutes).
The use of smartphone applications may reduce treatment times for endovascular therapy in acute ischemic stroke. Further studies are needed to confirm our findings.
最近发现成像至穿刺和成像至再灌注的指标与急性缺血性卒中血管内血栓切除术的临床结局相关。然而,对于血管内治疗,在医院内改善工作流程以获得更好的时间结果的措施在很大程度上尚未得到探索。本研究的目的是检验我们使用内部开发的新型智能手机应用程序来改善血管内治疗时间指标的经验。
我们开发了一个加密的智能手机应用程序,连接所有卒中团队成员,以加快沟通,并提供从中风发作到成像和穿刺的时间窗的同步实时更新。通过对我们单中心队列的二次分析来评估该应用程序对血管内治疗时间的影响。我们的主要结局是成像至穿刺时间。我们使用非参数统计显著性检验来评估结局。
在我们机构接受血管内治疗的66例连续急性缺血性卒中患者中,45例符合我们的分析标准。实施智能手机应用程序后,成像至穿刺时间显著缩短(应用前中位时间为127分钟;应用后时间为69分钟;P < 0.001)。穿刺至再灌注时间不受应用程序使用的影响(42分钟对36分钟)。
使用智能手机应用程序可能会缩短急性缺血性卒中血管内治疗的时间。需要进一步研究来证实我们的发现。