Could a Stroke Alarm Clock Play a Role in 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.

Researchers 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 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. Neurology Learning Network discussed these findings further with Klaus Fassbender, MD, professor of neurology at Saarland University Medical Center in Homburg, Germany.

Neurology Learning Network: What prompted you to conduct this study?

Dr Fassbender: While running a comprehensive stroke center, my colleagues and I often discussed that delays before treatment could be reduced by improved awareness about the time issue among the stroke team.

NLN: The results of your study indicated that the use of the stroke clock significantly improved acute stroke-management metrics. Could you discuss the significance of this finding?

Dr Fassbender: According to the “time is brain” paradigms shown in many trials, reduced time to treatment is generally considered to be associated with better outcomes. Therefore, our finding of a considerable time gain can be expected to be clinically relevant.

NLN: Did you anticipate these findings, or were any of them surprising to you?

Dr Fassbender: The findings in our study were anticipated, but this strategy needed to be demonstrated in a randomized study like ours.

NLN: What future research is needed regarding the stroke alarm clock?

Dr Fassbender: Larger studies that also track long-term outcomes (90 days) should be performed in the future.

NLN: What key takeaways about the stroke alarm clock do you hope to leave with neurologists and neurology providers?

Dr Fassbender: Because the “time is brain” concept is key in acute stroke management, this knowledge should be translated into daily clinical routines. The stroke clock may represent a low-cost measure to support this translation.

—Christina Vogt

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