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Salud Pública de México

Print version ISSN 0036-3634

Salud pública Méx vol.63 n.4 Cuernavaca Jul./Aug. 2021  Epub Feb 27, 2023

https://doi.org/10.21149/12437 

Cartas al editor

Increasing thrombolysis rate in acute ischemic stroke using a mobile instant messaging application: experience from a developing country

Aumento de la tasa de trombolisis en accidente cerebrovascular isquémico agudo usando una aplicación de mensajería instantánea: la experiencia de un país en desarrollo

Adolfo C Cordero-Pérez, MD, MSc1 

Edgar Botello-Hernández, MD1 

Alejandro González-Aquines, MD1 

Helda Sanchez-Teran, MD1 

Adrián Infante-Valenzuela, MD1 

Emanuel Escobar-Valdivia, MD1 

Diego A Cantú-García, MD1 

Sergio Castillo-Torres, MD1 

Carlos Soto-Rincón, MD1 

Erick A Garcia-Valadez, MD1 

Fernando Góngora-Rivera, MD, MSc1 

(1) Departamento de Neurología, Hospital Universitario Dr. José Eleuterio González y Facultad de Medicina, Universidad Autónoma de Nuevo León. Monterrey, Mexico.


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.

Table I Characteristics of stroke patients. Monterrey, Nuevo León, México, 2020 

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.

References

Sharma S, Padma MV, Bhardwaj A, Sharma A, Sawal N, Thakur S. Telestroke in resource-poor developing country model. Neurol India. 2016;64(5):934-40. https://doi.org/10.4103/0028-3886.190243 [ Links ]

Calleja-Castillo JM, Gonzalez-Calderon G. WhatsApp in stroke systems: Current use and regulatory concerns. Front Neurol. 2018;9:1-5. https://doi.org/10.3389/fneur.2018.00388 [ Links ]

Martins SCO, Weiss G, Almeida AG, Brondani R, Carbonera LA, de Souza AC, et al. Validation a smartphone application in the evaluation and treatment of acute stroke in a comprehensive stroke center. Stroke. 2020;51(1):240-6. https://doi.org/10.1161/STROKEAHA.119.026727 [ Links ]

Declaration of conflict of interests. The authors declare that they have no conflict of interests.

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