Stroke CDSS reduces 3-month vascular events by 26% in acute ischemic stroke patients

This multicenter, cluster randomized clinical trial (GOLDEN BRIDGE II) evaluated the efficacy of a stroke clinical decision support system (CDSS) on care quality and clinical outcomes in patients with acute ischemic stroke. The trial was conducted across 77 hospitals in China, with 38 hospitals randomized to the intervention group and 39 to the control group. From January 2021 to June 2023, 11,054 patients were enrolled in the intervention group and 10,549 in the control group; all patients were admitted within seven days after symptom onset. The intervention group received CDSS support including artificial intelligence-assisted imaging analysis, classification of stroke causes, and evidence-based treatment recommendations, while the control group provided usual care.

The primary outcome was a new vascular event (composite of ischemic stroke, hemorrhagic stroke, myocardial infarction, and vascular death) within three months after initial symptom onset. At three months, new vascular events occurred in 2.9% (320/11,054) of the intervention group compared with 3.9% (416/10,549) of the control group, with an adjusted hazard ratio of 0.74 (95% CI 0.58 to 0.93, P=0.01). The CDSS intervention effect remained significant in the cluster-level analysis (-0.01, 95% CI -0.02 to -0.004, P=0.003). For secondary outcomes, patients in the intervention group had a higher composite measure of evidence-based performance measures for acute ischemic stroke care quality (91.4% [77,049/84,276] vs 89.8% [70,794/78,834]; adjusted odds ratio 1.21, 95% CI 1.17 to 1.26, P<0.001). New vascular events were also significantly lower in the intervention group at 12 months (4.0% [440/11,054] vs 5.5% [576/10,549]; adjusted hazard ratio 0.73, 95% CI 0.56 to 0.95, P=0.02). No significant differences were found in disability (modified Rankin Scale score 3-6) and all-cause mortality at three, six, and 12 months. Safety outcomes—moderate or severe bleeding events and all bleeding events at three, six, and 12 months—did not differ significantly between the two groups.

The authors concluded that use of the stroke CDSS in patients with acute ischemic stroke in China led to a significant decrease in new vascular events at three months, improved stroke care quality, and decreased long-term vascular events.

Imagine you've just had a stroke. Your biggest fear is having another one. A major study across 77 hospitals in China tested whether a computer support system could help doctors give better care and prevent that from happening. The system analyzed brain scans, helped classify the type of stroke, and gave doctors evidence-based treatment recommendations. For patients whose doctors used this system, the results were clear: they were less likely to suffer a new vascular event—like another stroke or a heart attack—within the first three months. Specifically, 2.9% of patients in the system group had a new event, compared to 3.9% in the usual care group. This protective effect lasted, with fewer events still seen at 12 months. The system also helped doctors follow recommended care guidelines more consistently. Importantly, using the computer system did not lead to more bleeding complications, and there was no significant difference in disability or death rates between the two groups. The study shows that this kind of technological support can be a powerful tool to improve the quality of stroke care and help protect patients from future crises.