In an episode of WebMD’s YOUR HEALTH ON TECH with John Whyte, MD, Steven Messe, MD, discusses an innovation in stroke detection: a wristband that could alert hospital professionals for earlier intervention.
TRANSCRIPT OF VIDEO
JOHN WHYTE
A person has a stroke nearly every 40 seconds in the United States. Despite recent advances in treatment, there are still significant challenges after suffering a stroke. That’s why diagnosis is so important. We tend to think about strokes occurring in the community. But strokes can also occur in the hospital setting. And when they do, they often go undetected for over 4 hours.
My guest today has the device to change that, using a special wristband. It received FDA breakthrough designation last year and was also named one of Time magazine’s 200 Best Inventions of 2022. Joining me is Dr. Steven Messe. He’s a Professor of Neurology at the Hospital the University of Pennsylvania, as well as Associate Director of the Vascular Neurology Fellowship. Steve, it’s nice to see you.
STEVEN MESSE
Thanks, Dr. Whyte. Appreciate the opportunity to speak with you today.
JOHN WHYTE
Well, I have to start off because a lot of viewers are probably thinking strokes occur in the hospital? What’s going on here? Because you’re not talking about people who came in with stroke. Is that correct?
STEVEN MESSE
Absolutely correct. So about 10% overall of all the strokes that are occurring are happening under our noses in the hospital. And the issue is that people come in with diseases or are undergoing procedures that we know are high risk for stroke. And so they definitely can occur while we are taking care of these patients. And in particular, procedures of the heart, cardiovascular procedures, and the aorta, which is the main artery leaving the heart, you can have debris or a clot that can go up into the head and cause a stroke. So it definitely happens all the time.
JOHN WHYTE
But Steve, people are in a hospital setting, where there’s a lot of monitoring and a lot of oversight. So it still seems a bit surprising, doesn’t it, that your data shows it can take over 4 hours in the current environment if someone has a stroke in the hospital to actually be detected? Is that right?
STEVEN MESSE
That is. Yeah, that’s absolutely correct. And there are a number of challenges. Patients are in bed or bedbound, oftentimes sedated, coming out of anesthesia. And when you have a stroke, it’s not like a heart attack, where you have a lot of pain and maybe will wake up and say, I’m in pain. When you have a stroke, pain is not usually involved. But you may not be able to speak. You may not be able to move.
So the patients can’t necessarily tell the staff they’re having trouble. And as we all know, the nurses and doctors are working very hard in the hospital. But they can’t be in the room all the time. And so oftentimes things will go undetected for hours. And with stroke, as you mentioned, we have treatments that are amazing, but time is the most critical factor to getting a good outcome, even to be eligible for treatment. If you’re too late, you may not be eligible to be treated.
JOHN WHYTE
And that’s where diagnosis comes into play. We always talk about recognizing the signs and symptoms, which sometimes can be confusing, and then quick diagnosis. But when we think about the diagnosis, we often think about fancy imaging, right? We’re going to do a CT scan. We’re going to do an MRI, PET scan, and all these other type of scans. But your device involves a wristband. So tell us how you thought about that and how it works.
STEVEN MESSE
Yeah. So we recognized that this was a problem, that we weren’t catching the strokes fast enough. And we wanted to really work on that. And one of the hallmarks of stroke, one of the cardinal signs of stroke is weakness on one side of the body. And so we knew that’s what we wanted to tackle as sort of a low-hanging fruit for stroke detection. And accelerometers are ubiquitous and really sort of basic technology now, things that can measure movements very easily. We wear them on our smartwatches and our Fitbits.
And we knew, again, that asymmetric movement is a hallmark of stroke. So we put accelerometers on our patients’ wrists, patients who had a stroke and patients who didn’t have a stroke so that we could develop an algorithm that can differentiate between the two and detect when somebody has that weakness that’s indicative of stroke, to alert the staff to come check the patient and identify that stroke faster. So this has been going on for– something we’ve been working on for years now. And it took a long time to get the algorithm to work as we need it to because we can’t have it alerting the nurses all the time.
JOHN WHYTE
Sure.
STEVEN MESSE
You don’t want to have a lot of false alarms. But we also want to catch these strokes quickly.
JOHN WHYTE
Is it looking for subtle changes? Because let’s be fair. In the hospital setting, you’re not moving around too much. You’re kind of confined, for the most part, to that hospital bed, which is tight, to be honest, in moving your arms. So is it just looking for these small changes in terms of movement?
STEVEN MESSE
Yeah, that’s a great question, and it was something that we also were concerned about when we were developing this. Are we going to be able to have this work when people are sleeping or not? And in our validation study, we did 200 patients prospectively, patients with stroke or without stroke, it worked equal well whether it was daytime or nighttime. And we were thrilled to see that.
It was engineered to be that way. And when we saw that it actually worked as we hoped it would, it was very exciting for us. So it does pick up subtle findings and subtle differences to make that detection of stroke.
JOHN WHYTE
What about an outpatient setting? I’m sure that’s what everyone’s thinking about right now. How can I have this at home for a loved one? Or what’s its potential usage in a skilled nursing facility or a nursing home? Where do you see that developing? Is it going to be ready for that at some point in time?
STEVEN MESSE
Absolutely. We wanted to start in the hospital because we knew that it was an issue there, and we knew the patients who are at greatest risk for stroke. We knew when they were going to have their stroke. And we knew the nurses would be there to check the patient quickly. And we would use that, then, to help patients, but also to show that it works.
From there, obviously we’ll be able to develop it to go outside of the hospital and, exactly as you said, going to the rehab facilities and the nursing facilities. We know those patients are high risk. And then outside of those facilities and in the home as well, there’s no question that we could adapt this technology for those environments.
JOHN WHYTE
And is it currently being used in the hospital setting or primarily in a research setting right now?
STEVEN MESSE
It’s still in the research setting. We’re not selling it for clinical use yet. We need to do the final pivotal trials to prove that it is useful. But we hope to be initiating those very soon and getting those done as quickly as possible so that we can get them into clinical use.
JOHN WHYTE
And this doesn’t replace the fancy imaging that we’re referencing, correct, in terms of CT or MRI. It’s really about those early signs of diagnosis that then can help determine what level of care. Is that right?
STEVEN MESSE
Yeah, that is a really important point. So this, by no means, is not a diagnostic test. It doesn’t tell you if you had a stroke or not. It just tells you that you are moving in a way that could be indicative of stroke, and you need to have somebody come and check you out quickly. So the nurse would come by the bedside and do a neurologic exam, as they do intermittently throughout the day.
But the key is to do it at the right time. And from there, if they do see signs of a stroke that look concerning, you would then initiate a call to the stroke team in the hospital. And they would come by, and you would get all the studies that you mentioned, the CT scan, perfusion scans, and blood vessel studies, and if a stroke is confirmed, treat them as quickly as possible. But we would be the tip of the spear, then, to try to identify the movement that could be indicative of stroke.
JOHN WHYTE
And on this series Your Health On Tech, we’re talking about how more and more tools are going to be able to be used in the home, right? So we always focused on everything has to be done in the ER setting or the hospital setting. Is this a pattern that you think is going to accelerate in the next few years, partly because we’re more use to be able to do things at home? The same for the wristband, people are more accepting of having something on their wrist that can help impact their health?
STEVEN MESSE
Yeah. I think I think that is a reasonable expectation that we will be getting better and better at managing people’s diseases at home and treating them at home and diagnosing them outside of the hospital. And the goal, again, is to do it faster and better. So I think both people’s understanding and willingness to wear these things that can be so helpful to them is real. And then our ability to use these tools to help people, obviously, is growing rapidly. So it’s a very exciting time.
JOHN WHYTE
What’s stroke detection going to look like five years from now?
STEVEN MESSE
Wow. Five years is a relatively short time frame. But I really do hope that for the people that are at risk of stroke that we will have something that is easily worn and well tolerated that can help them identify the stroke quickly so that we can treat it. Obviously, we are continuing to develop those treatments and ways to prevent stroke as well. So we’re going to work at it from both ends.
JOHN WHYTE
And let’s just remind patients, what are those signs of strokes that they should call 911 if they or a loved one experience?
STEVEN MESSE
Great question. So if you have an unexplained severe headache like you’ve never had before, that can be signs of a stroke. If you develop sudden double vision or loss of vision, difficulty speaking or understanding, room spinning, incoordination, imbalance, numbness, tingling, or weakness, which typically occurs on half of your body, any of those signs could indicate a stroke. And again, stroke is a very time-critical disease. Every minute counts. So if that happens, call 911 is the right answer.
JOHN WHYTE
Good reminder. And if you have any question about it, you call 911. You don’t try to diagnose it yourself. Dr. Messe, thank you very much for taking the time today to talk to us about your technology and where we are with stroke detection.
STEVEN MESSE
Thank you. I appreciate it. Nice to talk you.
