September 24, 2020
2 min read
Fassbender and Fousse report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Acute stroke management metrics improved with use of an alarm clock in the CT room that indicated several target times up to therapy decision, researchers found.
“Time is brain,” Klaus Fassbender, MD, professor of neurology at Saarland University Medical Center in Homburg, Germany, said in a press release. “Minutes are easily lost in acute stroke management despite standard protocols. The stroke alarm clock is a low-cost intervention and an efficient way to quickly deliver life-saving treatment to acute stroke patients.”
Critical times throughout stroke care
For the randomized, prospective, unblinded trial published in Stroke, Mathias Fousse, MD, of the department of neurology at Saarland University Medical Center, and colleagues analyzed data from 107 patients with stroke between February 2016 and November 2017. Patients were assigned to care with a stroke clock (n = 51; median age, 75 years; 55% men) or to a control group (n = 56; median age, 78 years; 55% men).
Patients in the stroke clock group received care by a stroke team in a room equipped with a clock with a large digital display and a buzzer. An alarm demanding active feedback sounded at several times after admission: 15 minutes (end of clinical examination time), 25 minutes (treatment decision time) and 30 minutes (needle time). Visual and auditory alarms activated when time ran out for each target. The team could press a buzzer button before the alarm activated if the task was completed earlier than the given time limit. Patients in the control group received conventional stroke management without assistance from the clock.
The primary endpoint was time to therapy decision. Secondary endpoints included end of point-of-care laboratory, end of neurological examination, end of CTA and end of native CT, in addition to groin puncture time, needle time and achievement of recanalization. Researchers conducted a phone interview at 90 days to assess the modified Rankin Scale score.
The intervention group had significantly better times from door-to-therapy decision compared with the control group (16.73 minutes vs. 26 minutes; P < .001). Other improvements were also observed in this group, including end of neurological examination (7.28 minutes vs. 10 minutes; P < .001), end of CTA (14 minutes vs. 17.17 minutes; P = .001), end of CT (11.17 minutes vs. 14 minutes; P = .002), needle times (18.83 minutes vs. 47 minutes; P = .016) and end of point-of-care laboratory testing (12.14 minutes vs. 20 minutes; P < .001).
Door-to-recanalization time and door-to-groin puncture time seemed to be improved in the stroke clock group vs. the control group, although differences were not statistically significant.
Potential explanations for improvements
“The improvement of the stroke management metrics may be explained by the synergistic combination of increase in the participants’ awareness of the passing time by the stroke clock combined with the demand for active feedback by pressing the buzzer at target times,” Fousse and colleagues wrote. “Although it cannot be excluded that the intervention would also be effective without buzzing, however, a slight pressure by the soon anticipated alarm and the required feedback might have contributed to the acceleration of acute stroke management.”