Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Nov 4, 2020
Date Accepted: Jan 20, 2021
Use of a Smartphone Platform Help Emergency Management of Acute Ischemic Stroke: Two-year Observational Study
ABSTRACT
Background:
Series strategies were recommended to reduce door-to-needle (DTN) time for acute ischemic stroke (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.
Objective:
The study aims to describe the utility and application of a smartphone platform in the emergency management of AIS and report the DTN time for AIS patients during its 2-year application period. Results will be relevant to digital health management.
Methods:
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 the 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 1st 2018 to December 31th 2019, 8,457 patients diagnosed with AIS received intravenous tissue-type plasminogen activator therapy. The median DTN time and proportion of patients with DTN ≤60 min and ≤45 min were reported.
Results:
During the 2-year application period of this platform, the median DTN was 45 min and the proportions of patients with DTN ≤60 min and ≤45 min were 74.6% and 50.5%, respectively. The median DTN was significantly reduced from 50 min in 2018 to 42 min in 2019 (P<0.001). The proportion of patients with DTN ≤60 min and ≤45 min increased from 66.1% and 40.7% in 2018 to 80.7% and 57.3% in 2019 (both P<0.001). Sustained improvement in DTN 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 min) was significantly shorter than those who reached hospitals by themselves (47 min, P<0.001).
Conclusions:
Sustained reductions in DTN time reflected the improvement in AIS emergency management processes. The use of a smartphone platform integrating recommended strategies through the entire first aid stages is a practical way to help the emergency management of AIS. Clinical Trial: Not applicable.
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