Introduction: The use of mobile electronic care coordination via smartphone technology is a novel approach aimed at increasing efficiency in acute stroke care. One such platform, StopStroke© (Pulsara Inc., Bozeman, MT), serves to coordinate personnel (EMS, nurses, physicians) during stroke codes with real-time digital alerts. This study was designed to examine post-implementation data from multiple medical centers utilizing the StopStroke© application, and to evaluate the effect of method of arrival to ED and time of presentation on these results.
Methods: A retrospective analysis of all acute stroke codes using StopStroke© from 3/2013 – 5/2016 at 12 medical centers was performed. Preliminary unadjusted comparison of clinical metrics (door-to-needle time [DTN], door-to-CT time [DTC], and rate of goal DTN) was performed between subgroups based on both method of arrival (EMS vs. other arrival to ED) and time of day. Effects were then adjusted for confounding variables (age, sex, NIHSS score) in multiple linear and logistic regression models.
Results: The final dataset included 2589 unique cases. Patients arriving by EMS were older (median age 67 vs. 64, P < 0.0001), had more severe strokes (median NIHSS score 8 vs. 4, P < 0.0001), and were more likely to receive tPA (20% vs. 12%, P < 0.0001) than those arriving to ED via alternative method. After adjustment for age, sex, NIHSS score and case time, patients arriving via EMS had shorter DTC (6.1 min shorter, 95% CI [2, 10.3]) and DTN (12.8 min shorter, 95% CI [4.6, 21]) and were more likely to meet goal DTN (OR 1.83, 95% CI [1.1, 3]). Adjusted analysis also showed longer DTC (7.7 min longer, 95% CI [2.4, 13]) and DTN (21.1 min longer, 95% CI [9.3, 33]), and reduced rate of goal DTN (OR 0.3, 95% CI [0.15, 0.61]) in cases occurring from 1200-1800 when compared to those occurring from 0000-0600.
Conclusions: By incorporating real-time pre-hospital data obtained via smartphone technology, this analysis provides unique insight into acute stroke codes. Additionally, mobile electronic stroke care coordination is a promising method for more efficient and efficacious acute stroke care. Furthermore, early activation of a mobile coordination platform in the field appears to promote a more expedited and successful care process.