Smartphone-based Prehospital Stroke Triage Optimizes Workflow and Bridges the Off-hour Delays in Endovascular Thrombectomy

INTRODUCTION: Large vessel occlusion (LVO) stroke requires rapid endovascular thrombectomy (EVT). Prehospital LVO screening combined with smartphone-based real-time pre-notification 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 two 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 non-significant 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 < 60 min increased from 10.8% to 46.8%. Multivariate analysis identified the after period as an independent predictor of DTP < 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.