Stroke Alarm Clock Could Expedite Acute Stroke Management

The use of a stroke alarm clock that demands active feedback from stroke physicians was found to significantly improve metrics for acute stroke care, according to new findings published in Stroke.¹

“Time is brain. Minutes are easily lost in acute stroke management, despite standard protocols,” said study author Klaus Fassbender, MD, professor of neurology at Saarland University Medical Center in Homburg, Germany, in a press release. “The stroke alarm clock is a low-cost intervention and an efficient way to quickly deliver life-saving treatment to acute stroke patients.”²

Dr Fassbender and colleagues arrived at their conclusion after performing a randomized controlled study that included 107 participants (51 in the stroke clock group and 56 controls). For the study, a large-display alarm clock was installed in the computed tomography (CT) room, where physicians conducted admission, diagnostic work-up, and intravenous thrombolysis. The alarms coincided with the following target times after patients were admitted:

• Complete the neurological examination within 15 minutes
• Complete CT scanning and international normalized ratio determination via point-of-care laboratory testing within 25 minutes
• Initiate intravenous thrombolysis within 30 minutes

The clock required active feedback from stroke physicians through pressing a buzzer button, and the alarm could be avoided by hitting the button before time for each step ran out.

The primary end-point of the study was the conclusion of all diagnostic work-up that would help decide for or against recanalizing treatment. A neutral observer evaluated times to therapy decision, neurological examination, imaging, point-of-care laboratory testing, needle, and groin puncture. At day 90, the modified Rankin Scale was used to assess functional outcome.

The results of the study indicated that patients in the stroke clock arm demonstrated better metrics for stroke management compared with patients in the control arm. The authors observed improvements among stroke clock patients compared with controls for the following:

• Time from door to end of diagnostic work-up (16.73 minutes vs 26.00 minutes)
• Time from door to end of neurological examination (7.28 minutes vs 10.00 minutes)
• Time from door to end of CT (11.17 minutes vs 14.00 minutes)
• Time from door to end of CT angiography (14.00 minutes vs 17.17 minutes)
• Time from door to end of point-of-care laboratory testing (12.14 minutes vs 20.00 minutes)
• Time from door to needle (18.83 vs 47.00 minutes)

However, no significant differences in times from door to groin puncture or day-90 functional outcomes were observed.

—Christina Vogt

References:

1. Fousse M, Grün D, Helwig SA, et al. Effects of a feedback-demanding stroke clock on acute stroke management: a randomized study. Stroke. Published online September 24, 2020. doi:10.1161/STROKEAHA.120.029222
2. Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care. News release. American Heart Association. September 24, 2020. Accessed September 24, 2020. https://newsroom.heart.org/news/stroke-alarm-clock-may-streamline-and-accelerate-time-sensitive-acute-stroke-care?preview=8237