Technology for Acute Strokes – Interview with BrainAttack App Developerby Shaheen E Lakhan, MD, PhD, MEd, MS | June 12, 2013
FAST (Face drooping; Arm weakness; Speech difficulty; Time to call) is the educational meme the American Stroke Association uses. A clinican’s need for speed is also the driving force behind the BrainAttack iPhone app, developed by a brother and sister team.
Madhuri Koganti, MD, a practicing Dallas neurologist, and Balu Kadiyala, a Chicago-area technology expert, have created the app after years of working in emergency rooms and witnessing the delays in getting patients life-saving treatment that can reverse stroke and prevent permanent disability. Dr. Koganti discusses here how her app may help acute stroke management.
What treatment options are available for an acute stroke?
Stroke is a leading cause of permanent disability and premature death. Intravenous alteplase or tissue plasminogen activator (tPA) is the only FDA-approved treatment for acute stroke patients for over a decade. tPA significantly reduces permanent disability and mortality. Stroke occurs when a clot forms in the brain and compromises the blood flow to the brain, leading to brain damage. tPA dissolves the clot and restores the blood flow. The goal is to administer tPA to stroke patients as soon as possible.
The acute stroke patient evaluation in the emergency room has significantly changed in the past decade. Stroke protocols have been implemented at hospitals to expedite the evaluation of stroke patients in the ER to administer tPA as quickly as possible. Hospitals now deploy stroke teams so that patients can be evaluated quickly for tPA eligibility.
How does the BrainAttack App fit into this picture?
Although tPA is an FDA-approved treatment since the mid-1990s, it is still widely underused and the majority of stroke patients who could be eligible for tPA treatment have not been getting it. The American Stroke Association estimates that only 3% to 8% of potentially eligible patients receive tPA. One of the obstacles to this treatment involves the time-consuming process of determining whether a patient should receive tPA, especially since a wrong decision could lead to a patient’s premature death.
When it comes to treating stroke, time is critical, since during a stroke 1.9 million neurons die every minute. tPA must be given within 4.5 hours from the time of symptoms, however the goal is to give tPA as soon as possible. Doctors have to be sure patients are eligible to receive tPA.
Typically doctors spend 45 to 60 minutes with a laborious paper-based checklist containing 30-plus criteria to determine a patient’s eligibility. BrainAttack App reduces that process to just five minutes by guiding doctors through a list of yes or no questions via their iPhone. The questions are based on standard-of-care guidelines about patient symptoms and relevant medical history.
BrainAttack App processes the patient data and reaches a conclusion on whether the patient is ineligible, eligible, or eligible with cautions to receive tPA. There’s no need to hunt for the standard-of-care notebook and fill out length check lists. I have personally witnessed patients who have been deemed eligible through BrainAttack App to receive tPA treatment and walk out of the hospital the next day happy, healthy and on their way to continuing their productive lives. As a neurologist who is on call two weekends every month, I routinely have used the app to determine tPA eligibility for an average of two patients every weekend or roughly 50 patients each year. BrainAttack App has given me bedside access to a decision-support tool that has saved dozens of lives.
The goal of BrainAttack App is to allow physicians to apply technology during clinical decision-making process while quickly evaluating the acute stroke patients for tPA eligibility and administer tPA to improve patient’s outcomes.
In what realms of medicine has such technology been appropriately implemented?
Compared to other industries, computer and mobile technologies are being adopted very slowly in health care. Adaptation of automated standardized clinically applicable tools will allow physicians to provide quality care while reducing errors. However there is still hesitancy among some hospital-based systems and physicians to adopt newer technologies.
I believe the future will lead to huge growth in the number of health care providers and systems embracing technology, especially mobile phone apps that provide medical professionals with pocket-access to data and decision-guidance tools. If appropriately trialed and researched, these tools offer great promise in improving patient outcomes and reducing health care costs.
What is in the future of technology and neurology?
I believe technology tools offer promise to physicians who want to improve the care of their patients. Combining the use of smartphone apps with nationally approved standard-of-care guidelines and specific treatment modalities will definitely improve patient outcomes and enable them to lead healthy and productive lives.
It’s been nearly 50 years since doctors began using telemedicine to treat patients remotely and it’s now commonplace for evaluating stroke patients at hospitals nationwide. Technology made possible an aggressive time-based tPA treatment protocol for on-call neurologists, ER doctors and radiologist to collaborate remotely. Smart phones and app technologies represent the next major opportunity to create smart, clinically based tools for neurologists as well as other realms of medicine. The future depends on how quickly hospitals, clinics and other health care organizations act to make use of the apps systematic and widespread.
The BrainAttack App is available for download on iPhone. We encourage you to download the BrainAttack App and rate it on the iTunes store.
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