Dear editor: Thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) improves functional outcomes in stroke, but its use requires an accurate patient selection to increase post-stroke functional improvement. In our country, trained physicians for rt-PA use are few. In our Hospital (Hospital Univeristario José Eleuterio González), rt-PA is applied by the emergency medical team (EMT) made up primarily of residence in training with little experience in rt-PA use. The process involved the communication of every patient to the stroke specialists (SPs) using phone calls, which subsequently had to authorize its use, leading to low rates of rt-PA use. We created a chat in WhatsApp (WhatsApp, California, USA) between SPs and the EMT in July 2016. Within, stroke patients are presented with their CT/MR image. We evaluated the effect of this stroke chat on rt-PA use, door to needle times (DTN), and length of stay (LOS). We obtained data from an ongoing stroke registry. Patients with ischemic stroke admitted between January 2015 to December 2017 were included. Data were divided into two periods: pre (January 2015 - June 2016) and post (July 2016 - December 2017) use of the stroke chat. We used logistic regression for testing rt-PA use proportions, and linear regression for DTN and LOS. P-values <0.05 were considered statistically significant. 634 patients were included, 50.2% and 49.8% from pre- and post-periods, respectively (table I). rt-PA use increased from 2.83% in the pre-period to 8.86% in the post-period. Both LOS (5.1±4.4 vs 6.3±4.8) and DTN (102±54 vs 142±65.5) increased in the post-period, but DTN increase was not statistically significant. The increase of rt-PA use is in line with a previous report.1 This could be the result of improved coordination within the EMT to use rt-PA and reassurance by the SPs. In other words, SPs may improve the sense of safety of the EMT to use rt-PA. We also found an increase in LOS by 1.2 days. This is likely the result of a more robust patient evaluation promoted by SPs. Although WhatsApp could improve stroke care with no costs, data privacy concerns need to be considered.2 Martins and colleagues showed the utility of an app with similar characteristics to WhatsApp, which complies with the current regulations.3 These apps could close the gap that exists in stroke treatment due to the lack of SPs. In conclusion, WhatsApp is a cheap solution to improve stroke management. Our clinic will move to use other apps with full compliance with data privacy protection. In the meantime, patients continue to benefit from thrombolysis treatment.
Characteristics |
Pre-WhatsApp (n=318) No. (%) |
Post-WhatsApp (n=316) No. (%) |
OR Or B |
IC95% |
P |
Age (mean±SD) |
63 ± 14.36 |
58.9 ± 16.46 |
- |
- |
0.004 |
Male |
192 (60.37) |
187 (59.17) |
- |
- |
0.758 |
Number of thrombolysis |
9 (2.83) |
28 (8.86) |
3.39 |
1.56-7.36 |
.002* |
Hospital Stay Length (days) (SD) |
5.1 ± 4.4 |
6.3 ± 4.8 |
1.15 |
.40-1.90 |
.003* |
Door-to-needle time (SD) thrombolysis patients |
102.25 ± 54.63 |
154.88 ± 70.60 |
47.09 |
-14.08-108.27 |
1.24 |
Models were adjusted for age and sex. All Analyses were performed in SPSS v24.0.
*p value <0.05.
SD: Standard deviation.