The Effect of Smartphone Pre-Notification System on Regional Acute Ischemic Stroke Management Time Delay: Multicenter...

Prehospital notification is crucial for reducing door-to-reperfusion time in patients with acute ischemic stroke (AIS). However, evidence remains limited regarding the real-world effectiveness of smartphone-based prenotification systems, particularly when considering variations in system activation and utilization. In Daegu, a metropolitan city in South Korea, a mobile application-based prenotification system has been implemented to streamline acute stroke care. This study aims to analyze the effect of the pre-notification system on the reduction of treatment time delay in acute ischemic stroke.

This retrospective observational before-and-after study was conducted in Daegu, South Korea. The "before" period spanned December 2018 to November 2019, and the "after" period spanned December 2020 to November 2021. Patients diagnosed with AIS (first abnormal time < 6 h) who arrived at the emergency department via emergency medical service at five hospitals were included. Patients were divided into three groups based on the use of a smartphone application (FASTroke) before and after implementing the prehospital AIS notification system. Outcomes of time variables related to ischemic stroke management included scene-to-door time, Door-to-CT scan time (DTC), Door-to-intravenous thrombolysis time (DTI), and Door-to-endovascular thrombectomy time (DTE). The effect of FASTroke implementation on achieving the target time was analyzed through multivariable logistic regression analysis.

Among the 553 patients included in the final analysis, 177 were managed using the FASTroke system. Compared to the before group, the group that used FASTroke during the after period had significantly shorter DTC (23.0-20.0 min, p < 0.001), DTI (42.5-36.0 min, p = 0.044), and DTE (95.5-87.0 min, p = 0.049). Time reduction was even greater with hospital preregistration, including DTC (14.0 min), DTI (33.0 min), and DTE (66.5 min). Logistic regression revealed that FASTroke use significantly increased the odds of achieving DTC < 20 min (adjusted odds ratio 1.971; 95% confidence interval (CI), 1.319-2.945) and DTE < 90 min (aOR 2.010; 95% CI, 1.014-3.985), with even higher odds in the preregistration subgroup.

The FASTroke system significantly improved in-hospital treatment timelines-DTC, DTI, and DTE-particularly through its preregistration feature.