Smartphone Use in the Management of Neurological Emergencies: A Simulation-Based Study

Melissa B Pergakis; Afrah A Ali; WanTsu Wendy Chang; Benjamin Neustein; Casey Albin; Aimee Aysenne; Samuel A Tisherman; Nicholas A Morris

doi:10.1007/s12028-024-02000-7

Smartphone Use in the Management of Neurological Emergencies: A Simulation-Based Study

Neurocrit Care. 2024 May 21. doi: 10.1007/s12028-024-02000-7. Online ahead of print.

Authors

Melissa B Pergakis^{1

2

3

4}, Afrah A Ali^{5

6}, WanTsu Wendy Chang^{5

6}, Benjamin Neustein⁵, Casey Albin⁷, Aimee Aysenne⁸, Samuel A Tisherman^{5

9}, Nicholas A Morris^{5

10}

Affiliations

¹ Program in Trauma, University of Maryland School of Medicine, Baltimore, USA. mpergakis@som.umaryland.edu.
² Departments of Neurology, University of Maryland School of Medicine, Baltimore, USA. mpergakis@som.umaryland.edu.
³ Division of Neurocritical Care and Emergency Neurology, University of Maryland Medical Center, 22 S. Greene St., G7K18, Baltimore, MD, 21201, USA. mpergakis@som.umaryland.edu.
⁴ R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, USA. mpergakis@som.umaryland.edu.
⁵ Program in Trauma, University of Maryland School of Medicine, Baltimore, USA.
⁶ Departments of Emergency Medicine, University of Maryland School of Medicine, Baltimore, USA.
⁷ Department of Neurology and Neurosurgery, Emory University School of Medicine, Atlanta, USA.
⁸ Department of Neuroscience, Tulane University School of Medicine, New Orleans, USA.
⁹ Departments of Surgery, University of Maryland School of Medicine, Baltimore, USA.
¹⁰ Departments of Neurology, University of Maryland School of Medicine, Baltimore, USA.

PMID: 38773041
DOI: 10.1007/s12028-024-02000-7

Abstract

Background: Smartphone use in medicine is nearly universal despite a dearth of research assessing utility in clinical performance. We sought to identify and define smartphone use during simulated neuroemergencies.

Methods: In this retrospective review of a prospective observational single-center simulation-based study, participants ranging from subinterns to attending physicians and stratified by training level (novice, intermediate, and advanced) managed a variety of neurological emergencies. The primary outcome was frequency and purpose of smartphone use. Secondary outcomes included success rate of smartphone use and performance (measured by completion of critical tasks) of participants who used smartphones versus those who did not. In subgroup analyses we compared outcomes across participants by level of training using t-tests and χ² statistics.

Results: One hundred and three participants completed 245 simulation scenarios. Smartphones were used in 109 (45%) simulations. Of participants using smartphones, 102 participants looked up medication doses, 52 participants looked up management guidelines, 11 participants looked up hospital protocols, and 13 participants used smartphones for assistance with an examination scale. Participants found the correct answer 73% of the time using smartphones. There was an association between participant level and smartphone use with intermediate participants being more likely to use their smartphones than novice or advanced participants, 53% versus 29% and 26%, respectively (p < 0.05). Of the intermediate participants, those who used smartphones did not perform better during the simulation scenario than participants who did not use smartphones (smartphone users' mean score [standard deviation] = 12.3 [2.9] vs. nonsmartphone users' mean score [standard deviation] = 12.9 (2.7), p = 0.85).

Conclusions: Participants commonly used smartphones in simulated neuroemergencies but use didn't confer improved clinical performance. Less experienced participants were the most likely to use smartphones and less likely to arrive at correct conclusions, and thus are the most likely to benefit from an evidence-based smartphone application for neuroemergencies.

Keywords: Medical education; Simulation; Smartphone technology.