NPR's iPhone app helps doctor recommend treatment for stroke patient

I use the NPR app to keep that smug-all-over feeling of intellectual superiority in all members of my family when traveling in states where scrapple is as close as one can get to a vegetable. Why be just healthy when you can be healthiER?

Another example of terrible, lazy reporting by NPR and TUAW. A 5 minute search between cases revealed the following.

Ms. Gill was treated at Northwestern Memorial Hospital. Per their health report card, 80% of their patients who present within 120 minutes of "the time last known well" have IV tPA adminsitered within 180 minutes.

http://www.nmh.org/cs/Satellite?c=eHA_Content_C&cid=1244665638443&pagename=nm%2FCentral_Template

From the moment they were notified that she was being transported to NMH, the stroke team would have been preparing to give tPA upon arrival whether the family "called in with this information" or not.


There is a Joeseph Hastings MD who is a Rad Onc resident (Pgy-4) at Kaiser in LA. While stroke management is well outside of the realm of Rad Onc care, it seems remarkably unlikely that someone smart enough to get into Rad Onc would not be well aware of tPA usage for stroke treatment.

I suspect that the real contribution of the original story to this patient/ family is summed up part way through the NPR article

"Joe Hastings says the NPR story gave his family a lot of "comfort and hope" in the midst of a crisis. "As my mom said, to know that someone had walked down almost that exact same road before and had done so well was really encouraging," he says."

- pod

Ha Ha Ha Ha Ha.

ROFL.

This is nearly as stupid as the idea that Gregory House, MD is a good doctor.

I agree with the above comments that it is extremely unlikely (even impossible) that the NPR story delivered by iPhone alerted this lady's physicians, in an accredited emergency department, to the utility of tPa for stroke.

However, there is relatively new data supporting an extended window for IV tPa administration after acute stroke (ie. out to 4.5 hours) that may have had a significant impact on its administration.

As most who have used (and appropriately held) this medication know it can be difficult to get a patient from first symptoms to a stroke centre, hemodynamics stabilized, through neuroimaging, establish a diagnosis, rule out contraindications and get the medication running all in under 3 hours.

I'm pleased that this lady had a positive outcome and that we new tools for knowledge translation.

I give tPA to patients with an acute ischemic stroke. It happens so infrequently, however, that I don't trust myself to recall the exact dose from memory. So, I whip out my iPhone and look up the exact dose in a pharmacology reference book (two different "books", actually, to minimize the risk of a typo leading me astray) My iPhone has been "saving lives" ever since I bought it, as did my Palm Treo before it, and the small paper book I carried in my pocket before that.

I use Gray's Anatomy iPhone app to show my patients pictures of the anatomy they have injured so they can get a better feel for the problem. Very useful and quick.

I concur with my industry friends about the TUAW short on the story. You do need to read the original in its full context.

What it does sound like is that the patient was presenting with a very specific condition that would normally follow one line of treatment (no tPA - especially if not treated within the first few hours). However, the symptoms were also (interpretation here) actually for a specific type of stroke that normal evaluations would not catch. I know from the cardio side of the body that there are very specific but rare conditions that are extremely hard to diagnose unless you are looking specifically for them... ones that need very specific and very rapid response or death will be inevitable.... and most of those patients do die because of this.

The body is very complex and as much as we know about it... we know very little.

That aside... tPA is a very dangerous drug to administer due to its principle affect and how that relates to its more dangerous side effect. A very small percentage of patients get it and it does require much attention.

Btw - as a side note. tPA is also used for myocardial incidents (aka Heart Attack). but it also has been found that 80-160mg of "baby" aspirin is as effective at the onset of the incident. Interesting to compare a $2000 drug versus the .20¢ aspirin

That's a great story. :)

As a practicing physician I find a couple of things alarming...

1) This article makes it seem like the ER physician didn't know to use tPA for a stroke. That is utter nonsense unless he graduated from underwater basket weaving school and forged his MD. Any doctor that hasn't heard of tPA in this day and age needs to have his license revoked.

2) Apparently the patient's brother who is a physician had never heard of tPA?!? Refer to comment #1.

3) I'm a radiologist and I'm acutely aware of tPA. Might have to do with the fact that I'm reading Head CT's on a regular basis, but this is common medical student level knowledge these days.

I seriously recommend that Megan Lavey's headline and the NPR article to which she refers (or at least the angle it presents) be taken with a grain of salt. t-PA is NOT some rare treatment that it takes some research on iphone app and NPR to enlighten the treating physicians before it is used.

For those who don't want to read the original stroke article mentioned, t-PA has been used for YEARS and YEARS. t-PA is in the arsenal of hospitals all over the world, and whether it is used or not, is listed in the stroke treatment algorithms learned by all physicians (especially ER, neurologists, internists). It is frequently considered as a possible treatment once a stroke patient is considered a candidate after a new cerebrovascular bleed is excluded, the time window of treatment can be confidently established, and other factors related to potential bleeding are evaluated.

To imply that the Chicago doctors needed a push in the right direction to give t-PA from someone in California who read an NPR article is a ridiculous insult.