Title : Validation of instadx, a clinical decision support tool information technology based application for ischemic stroke sub-type diagnosis
Abstract:
Globally ischemic stroke is the second leading cause of mortality and morbidity among the adult population. Prompt diagnosis of ischemic stroke sub-type can lead to better clinical outcomes. This study aimed to adapt and develop mHealth-based android application ‘InstaDx’ and validate the application in two phases, to assist ischemic stroke sub-type diagnosis for use among neurology residents against a Stroke Expert. InstaDx uses an evidence-based algorithm to diagnose ischemic stroke sub-type in the presence of multiple competing mechanisms to minimize misdiagnosis and improve prognosis. In the first phase, algorithms of sub-type diagnosis were created through standard guidelines and then transferred into InstaDx. In the second phase, a validation study was conducted at Aga Khan University Hospital, Karachi. 228 consecutive patients of age ≥18 years (62.59±14.60), presenting in the emergency department with neurological deficits consistent with stroke were recruited and InstaDx was used by residents. 11.84% of patients receive revascularization with tissue plasminogen activator. Sensitivity and specificity of InstaDx for large artery atherosclerosis were 65.91 and 73.57%, small artery atherosclerosis was 56.25 and 84.18 % and cardio aortic embolism was 58.33 and 99.17%, respectively against Stroke Expert diagnosis. Focus group discussions were used to assess the user feedback in third phase which revealed acceptance of InstaDx as an educational tool by the residents suggesting advanced diagnostic capacities. InstaDx proved to be a valuable sensitive and highly specific mHealth-based application for diagnosing subtypes of ischemic stroke. It provides a standard algorithm to confidently assess ischemic stroke patients. Clinical-Trials-Registration-URL:https://clinicaltrials.gov/ct2/show/NCT03080233
Audience Take Away Notes:
- The design and adaptation of algorithm is evidence based, developed under the supervision of stroke expert and health care professionals unlike the other available marketed health apps
- To the best of knowledge, InstaDx is the first validation study for diagnosis of sub-type of stroke on the basis of etiology against gold standard as many of the applications available in market are not validated and various available applications targeting more towards symptoms of stroke and anatomical identification of ischemic stroke.
- InstaDx was validated in specialized tertiary care center where we have standard stroke pathway protocols to minimize the variability in treatment modality offered to patients and variability in diagnosing ischemic sub-type of stroke.
- We have qualitatively measured uptake and feasibility of the app through focus group discussion
- InstaDx has the potential to be used in a busy ER and hospital setting. It can also be used in rural areas where specialized stroke care is not available. InstaDx will fulfill the need to strengthen the evidence based training for the residents working in stressful high volume environments.
- The InstaDx Clinical Decision Support software adds local evidence for an implementable solution to the lack of diagnostic support in busy LMIC settings.
