Feasibility and utility of an integrated medical imaging and informatics smartphone system for management of acute stroke

Abstract

Background Rapid dissemination and coordination of clinical and imaging data among multidisciplinary team members are essential for optimal acute stroke care. Aim To characterize the feasibility and utility of the Synapse Emergency Room mobile (Synapse ERm) informatics system. Methods We implemented the Synapse ERm system for integration of clinical data, computerized tomography, magnetic resonance, and catheter angiographic imaging, and real-time stroke team communications, in consecutive acute neurovascular patients at a Comprehensive Stroke Center. Results From May 2014 to October 2014, the Synapse ERm application was used by 33 stroke team members in 84 Code Stroke alerts. Patient age was 69.6 (±17.1), with 41.5% female. Final diagnosis was: ischemic stroke 64.6%, transient ischemic attack 7.3%, intracerebral hemorrhage 6.1%, and cerebrovascular-mimic 22.0%. Each patient Synapse ERm record was viewed by a median of 10 (interquartile range 6-18) times by a median of 3 (interquartile range 2-4) team members. The most used feature was computerized tomography, magnetic resonance, and catheter angiography image display. In-app tweet team, communications were sent by median 1 (interquartile range 0-1, range 0-13) users per case and viewed by median 1 (interquartile range 0-3, range 0-44) team members. Use of the system was associated with rapid treatment times, faster than national guidelines, including median door-to-needle 51.0 min (interquartile range 40.5-69.5) and median door-to-groin 94.5 min (interquartile range 85.5-121.3). In user surveys, the mobile information platform was judged easy to employ in 91% (95% confidence interval 65%-99%) of uses and of added help in stroke management in 50% (95% confidence interval 22%-78%). Conclusion The Synapse ERm mobile platform for stroke team distribution and integration of clinical and imaging data was feasible to implement, showed high ease of use, and moderate perceived added utility in therapeutic management.

Using a Smartphone Application for the Accurate and Rapid Diagnosis of Acute Anterior Intracranial Arterial Occlusion: Usability Study

“…The study results show that the smartphone application yielded an accurate diagnosis of anterior intracranial arterial occlusion in times similar to diagnoses completed using the hospital-based desktop PC monitor. Several studies have reported the use of smartphone applications for the management of stroke [ 4 , 13 - 15 ]; however, no study has reported their use for assessing LVO. To the best of our knowledge, this is the first article to examine interdevice agreement and compare interpretation times for MRA and HVS on FLAIR imaging between a smartphone application and a hospital desktop PC monitor.…”

“…The study results show that the smartphone application yielded an accurate diagnosis of anterior intracranial arterial occlusion in times similar to diagnoses completed using the hospital-based desktop PC monitor. Several studies have reported the use of smartphone applications for the management of stroke [4,[13][14][15]; however, no study has reported their use for assessing LVO.…”

Prehospital Notification Using a Mobile Application Can Improve Regional Stroke Care System in a Metropolitan Area

“…Studies have recently been conducted to remotely check the clinical aspects, data, and scans of patients through smartphones to provide better treatment for patients with acute ischemic stroke. 15 16 17 Despite the limitations of small-scale research conducted in a single hospital, a recent study showed a reduction in door-to-needle times of 40 minutes using a mobile app in the prehospital setting. 18 Consistent with prior studies, these results were confirmed in our study in a metropolitan setting; when the FASTroke app was activated, the percentage of patients who received reperfusion treatment was 9.8% higher for IVT alone and 11.3% higher for IVT plus EVT treatment.…”

Mobile Apps: An Emerging Tool to Improve Acute Stroke Care

“…There have been other reports of mobile apps being successfully deployed with similar results. 9,10 Increased visibility of team performance and immediate feedback from the app are additional motivators for improvement. Stroke care is unique in that a considerable amount of evaluation over separate facilities is required in a relatively narrow window, thereby making such a mobile app-based strategy especially valuable.…”

“…There have been other reports of mobile apps being successfully deployed with similar results. 9,10 Stroke care is unique in that a considerable amount of evaluation over separate facilities is required in a relatively narrow window, thereby making such a mobile app-based strategy especially valuable. Similar app-based solutions are already available for myocardial infarction, trauma and sepsis.…”