Prehospital
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Neurology

Smartphone-Based Prehospital Stroke Triage Optimizes Workflow and Bridges the Off-Hour Delays in Endovascular Thrombectomy.

Yuki Yamamoto, Nobuaki Yamamoto, Kenji Shimada, Yasuhisa Kanematsu, Kazutaka Kuroda, Izumi Yamaguchi, Manabu Ishihara, Takeshi Miyamoto, Masaaki Korai, Yuishin Izumi, Yasushi Takagi

Cerebrovascular diseases (Basel, Switzerland) · 2026-08-07 · Observational study

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Abstract

INTRODUCTION: Large-vessel occlusion (LVO) stroke requires rapid endovascular thrombectomy (EVT). Prehospital LVO screening combined with smartphone-based real-time prenotification may accelerate in-hospital activation, but supporting evidence remains limited. We evaluated a regional prehospital triage system integrating the Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale with the JoinTriage application. METHODS: We conducted a single-center observational study comparing patients transported with suspected stroke before (2020-2021) and after (2022-2024) system implementation. During the after period, emergency medical service personnel used JoinTriage to share FAST-ED scores and clinical data in real time. We compared clinical characteristics and workflow metrics, including door-to-puncture (DTP) time, across the 2 periods. RESULTS: The cohort included 721 patients (before, n = 262; after, n = 459). The LVO rate was significantly higher in the after period (25.5% vs. 18.7%, p = 0.043), with a numerically higher but nonsignificant EVT rate (19.4% vs. 14.1%, p = 0.083). Among FAST-ED/JoinTriage-triaged patients (193/459, 42.0%), LVO and EVT rates were further enriched, reaching 35.8% and 24.4%, respectively. Among EVT-treated patients, median DTP decreased from 88 to 62 min (p < 0.001), and DTP of <60 min increased from 10.8% to 46.8%. Multivariate analysis identified the after period as an independent predictor of DTP of <60 min (adjusted odds ratio, 4.76; p = 0.019). The trend toward prolonged DTP during off-hours observed in the before period (p = 0.054) was resolved in the after period. CONCLUSION: The smartphone-based FAST-ED triage system was associated with a higher concentration of suspected LVO patients at the receiving hospital, as well as streamlined in-hospital workflow and reduced off-hour treatment delays.

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Tags

Communication & handover · Time intervals · Triage instruments

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