But you still don't know how fast tPA has to be delivered to get 100% recovery. I bet it is in the ambulance, prior to hospital. So you don't even have the correct goal. And to do that you'll need to implement one of these fast diagnosis items.
fast diagnosis (66 posts)
Impact of RapidAI mobile application on treatment times in patients with large vessel occlusion
Abstract
Background Current efforts to reduce door to groin puncture time (DGPT) aim to optimize clinical outcomes in stroke patients with large vessel occlusions (LVOs). The RapidAI mobile application (Rapid Mobile App) provides quick access to perfusion and vessel imaging in patients with LVOs. We hypothesize that utilization of RapidAI mobile application can significantly reduce treatment times in stroke care by accelerating the process of mobilizing stroke clinicians and interventionalists.
Methods We analyzed patients presenting with LVOs between June 2019 and October 2020. Thirty-one patients were treated between June 2019 and March 2020 (pre-app group). Thirty-three patients presented between March 2020 and October 2020 (post-app group). Mann–Whitney U test and Kruskal–Wallis tests were used to examine variables that are not normally distributed. In a secondary analysis we analyzed interhospital time metrics between primary stroke centers and our comprehensive stroke center.
Results Baseline demographic and vascular risk factors were similar in both groups. Use of Rapid Mobile App resulted in 33 min reduction in DGPT (P=0.02), 35 min reduction in door to first pass time (P=0.02), and 37 min reduction in door to recanalization time (P=0.02) in univariate analyses when compared with patients treated pre-app. In a multiple linear regression model, utilization of Rapid Mobile App significantly predicted shorter DGPT (P=0.002). In an adjusted model, National Institutes of Health Stroke Scale (NIHSS) 24 hours after procedure and at discharge were significantly lower(NOT GOOD ENOUGH, 100% RECOVERY IS THE ONLY GOAL IN STROKE!) in the post-app group (P=0.03). Time of transfer between primary and comprehensive stroke center was comparable in both groups (P=0.26).
Conclusion In patients with LVOs, the implementation of the RapidAI mobile application was independently associated with reductions in intrahospital treatment times.
Data availability statement
Individual participant data that underlie the results reported in this study after deindentification are available upon reasonable request. Study analysis and analytic code will also be available. Data will be available beginning 3 months and ending 5 years after publication to researchers who propose a methodologically sound proposal. Proposals should be directed to the corresponding author at malkawa3@jhmi.edu.
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