Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Peking, China.
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
JMIR Mhealth Uhealth. 2021 Feb 9;9(2):e25488. doi: 10.2196/25488.
To improve the outcomes of acute ischemic stroke (AIS), timely thrombolytic therapy is crucial. Series strategies were recommended to reduce door-to-needle (DTN) time for AIS. Mobile technologies are feasible and have been used in stroke management for various purposes. However, the use of smartphone platforms that integrate series strategies through the entire first aid process to improve emergency management of AIS remains to be verified.
This study aims to describe the utility and application of a smartphone platform in the emergency management of AIS and report the DTN time for patients with AIS during its 2-year application period. Our results are relevant to digital health management.
A smartphone platform named "Green" was developed to incorporate the field assessment, hospital recommendation, prehospital notification, real-time communication, clinical records creation, key time-stamping, and quality control to streamline and standardize overall AIS emergency management processes. The emergency medical system (EMS) and all the emergency departments in Beijing have used this platform since 2018. From January 1, 2018, to December 31, 2019, 8457 patients diagnosed with AIS received intravenous tissue-type plasminogen activator therapy. The median DTN time and the proportions of patients with DTN times of ≤60 minutes and ≤45 minutes were reported.
During the 2-year application period of this platform, the median DTN time was 45 minutes, and the proportions of patients with DTN times of ≤60 minutes and ≤45 minutes were 74.6% and 50.5%, respectively. The median DTN time was significantly reduced from 50 minutes in 2018 to 42 minutes in 2019 (P<.001). The proportions of patients with DTN times of ≤60 minutes and ≤45 minutes increased from 66.1% and 40.7%, respectively, in 2018 to 80.7% and 57.3%, respectively, in 2019 (both P<.001). Sustained improvement in DTN time was seen during all the observed months. The improvement occurred across all facilities, and the variations among hospitals also decreased. The median DTN time for patients transferred by ambulances (43 minutes) was significantly shorter than those who reached hospitals by themselves (47 minutes; P<.001).
Sustained reductions in DTN time reflected the improvement in AIS emergency management processes. The use of a smartphone platform integrating recommended strategies throughout all first aid stages is a practical way to help the emergency management of AIS.
为改善急性缺血性脑卒中（AIS）的预后，及时进行溶栓治疗至关重要。为了降低 AIS 的门到针（DTN）时间，推荐了一系列策略。移动技术是可行的，并已在各种目的的卒中管理中得到应用。然而，使用智能手机平台通过整个急救过程整合一系列策略以改善 AIS 的紧急管理，仍有待验证。
本研究旨在描述智能手机平台在 AIS 急救管理中的应用，并报告 AIS 患者在其 2 年应用期间的 DTN 时间。我们的结果与数字健康管理相关。
开发了一个名为“Green”的智能手机平台，以整合现场评估、医院推荐、院前通知、实时沟通、临床记录创建、关键时间戳和质量控制，以简化和规范整体 AIS 急救管理流程。自 2018 年以来，北京市的急救医疗系统（EMS）和所有急诊部门都使用了该平台。2018 年 1 月 1 日至 2019 年 12 月 31 日，8457 例诊断为 AIS 的患者接受了静脉组织型纤溶酶原激活剂治疗。报告了中位 DTN 时间和 DTN 时间≤60 分钟和 DTN 时间≤45 分钟的患者比例。
在该平台应用的 2 年期间，中位 DTN 时间为 45 分钟，DTN 时间≤60 分钟和 DTN 时间≤45 分钟的患者比例分别为 74.6%和 50.5%。2019 年 DTN 时间中位数从 2018 年的 50 分钟显著缩短至 42 分钟（P<.001）。2018 年 DTN 时间≤60 分钟和 DTN 时间≤45 分钟的患者比例分别为 66.1%和 40.7%，2019 年分别增加至 80.7%和 57.3%（均 P<.001）。所有观察月份均观察到 DTN 时间持续改善。改进发生在所有设施中，医院之间的差异也有所减少。由救护车转运的患者的中位 DTN 时间（43 分钟）明显短于自行到达医院的患者（47 分钟；P<.001）。
DTN 时间的持续缩短反映了 AIS 急救管理流程的改进。使用智能手机平台在整个急救阶段整合推荐策略是帮助 AIS 紧急管理的一种实用方法。
