Department of Neurology (M.F., D.G., S.A.H., S. Walter, M.L., M.B., K.F.), Saarland University Medical Center, Homburg, Germany.
Institute of Medical Biometry, Epidemiology, and Medical Informatics (A.B., S. Wagenpfeil), Saarland University Medical Center, Homburg, Germany.
Stroke. 2020 Oct;51(10):2895-2900. doi: 10.1161/STROKEAHA.120.029222. Epub 2020 Sep 24.
This randomized study aimed to evaluate whether the use of a stroke clock demanding active feedback from the stroke physician accelerates acute stroke management.
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.
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, <0.001), (2) end of neurological examination (7.28 versus 10.00 minutes, <0.001), (3) end of computed tomography (11.17 versus 14.00 minutes, =0.002), (4) end of computed tomography angiography (14.00 versus 17.17 minutes, =0.001), (5) end of point-of-care laboratory testing (12.14 versus 20.00 minutes, <0.001), and (6) needle times (18.83 versus 47.00 minutes, =0.016) were improved. In contrast, door-to-groin puncture times and functional outcomes at day 90 were not significantly different.
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.
本随机研究旨在评估使用要求卒中医生主动反馈的卒中时钟是否能加快急性卒中管理。
在本随机对照研究中，在进行入院、诊断检查和静脉溶栓的计算机断层扫描室安装了一个大屏幕闹钟。入院后设定以下目标时间的闹钟：（1）15 分钟（完成神经检查）；（2）25 分钟（完成计算机断层扫描和即时检验国际标准化比值测定）；（3）30 分钟（开始静脉溶栓）。负责的卒中医生必须通过按蜂鸣器按钮主动提供反馈。在超时前按按钮可以避免闹钟响。治疗决策时间（主要终点，定义为完成所有诊断检查所需的时间，以决定是否进行再通治疗）、神经检查、影像学、即时检验、穿刺针和腹股沟穿刺时间由中立观察者评估。在第 90 天评估功能结局（改良 Rankin 量表）。
在 107 名参与者中，51 名卒中时钟患者的卒中管理指标优于 56 名对照患者。从入院到（1）完成所有指定诊断检查（治疗决策时间；16.73 分钟比 26.00 分钟，<0.001）、（2）完成神经检查（7.28 分钟比 10.00 分钟，<0.001）、（3）完成计算机断层扫描（11.17 分钟比 14.00 分钟，=0.002）、（4）完成计算机断层血管造影（14.00 分钟比 17.17 分钟，=0.001）、（5）完成即时检验实验室检查（12.14 分钟比 20.00 分钟，<0.001）和（6）穿刺针时间（18.83 分钟比 47.00 分钟，=0.016）均有所改善。相比之下，门到腹股沟穿刺时间和第 90 天的功能结局没有显著差异。
本研究表明，使用要求主动反馈的卒中时钟可显著改善急性卒中管理指标，因此，代表了一种简化时间敏感型卒中治疗的潜在低成本策略。
