Overview of Key Functions

1) The screenshot below shows the ‘Patient Details’ that need to be entered by the treating clinician for an individual patient.

2) After entering the patient’s details, the treating clinician then selects ‘Calculate outcomes’.

3) COMPASS then generates numerical (percentages and natural frequencies – out of 100 patients) and graphical risk presentations for the following outcomes at 3 months with and without thrombolysis:

Independence [complete recovery or minor disability, mRS 0 to 2] – green.

Dependence [moderate to severe disability, mRS 3 to 5] – amber.

Death – black.

Risk of symptomatic intracranial haemorrhage (SICH) and impact of any.

The default graphical risk presentation is coloured pictographs (shown here). By selecting the tabs at the top of the output screen, the same information is displayed in the form of bar charts or flow diagrams alongside stacked bar graphs.

4) This box shows the overall likely net benefit (or harm) from treatment with thrombolysis.

The information in the output screen can be used by clinicians as a guide to decide whether or not offer thrombolysis to stroke patients, and they can show the information on benefits/risks of thrombolysis (via the screen or on paper) to patients/relatives to support high-quality consent and shared decision making.

Additional Features and Tools

Calculator icons to the right of several text boxes can be used to access additional features, which in current practice are largely undertaken using paper-based materials.

  • 1. Glucose convertor (mg/dl to mmol/L)

  • 2. National Institute of Health Stroke Scale (NIHSS)

  • 3. Weight conversion (stones/lbs to Kg)

  • 4. Calculated onset time to treatment in minutes (derived from patient values entered for onset time and estimated time likely to treat)

  • 5. Thrombolysis (rt-PA) dosage calculator (derived from value entered for a patient’s weight).

    Selecting this shows figures for:

    Total rt-PA dose (mg)

    10% bolus (ml)

    90% IV infusion (ml/hr)

    No of 50mg rt-~PA vials needed

NIHSS Calculator

An electronic version of the NIHSS (used by trained qualified stroke physicians to assess the severity and extent of impairments due to stroke) is embedded in COMPASS.

By selecting the numerical value for the corresponding category in the NIHSS a textual description for the value selected is displayed to the right of the screen.

Timeline Graph

After patient details have been populated and the treating clinician has selected ‘calculate outcomes, by selecting the timeline tab the following information is displayed:

• Numerical values (out of 100 patients) for predicted net benefit (mRS 0 to 2) from thrombolytic treatment as a function of increasing stroke onset time to treatment in 15 minutes intervals.

• The same information is shown in the line graph (green line).

Save functionality

Print functionality

Using COMPASS as a clinical training aid

As mentioned earlier, to enhance patient safety and security with data validation, COMPASS supports ‘instant validation’ of entered patient values on continuous variables in accordance with the current licensing criteria for thrombolysis.

Calculated onset time to treatment (≤ 270 mins / 4.5 hours)

Age (18-80)Glucose (BM) ≥ 2.8 and ≤ 22.2)

Systolic blood pressure (≥ 40 and ≤ 185)

NIHSS score (≥ 5 and ≤ 25)

Weight (not part of the licensing criteria, but for the Glucose (BM) ≥ 2.8 and ≤ 22.2)Systolic blood pressure (≥ 40 and ≤ 185)

NIHSS score (≥ 5 and ≤ 25)

Weight (not part of the licensing criteria, but for the Systolic blood pressure (≥ 40 and ≤ 185)NIHSS score (≥ 5 and ≤ 25)

Weight (not part of the licensing criteria, but for the NIHSS score (≥ 5 and ≤ 25)

Weight (not part of the licensing criteria, but for the purposes of patient safety and security with data validation the valid value ranges are ≥ 40 and ≤ 635)

Various scenarios (based on real or simulated patients) can be used to facilitate learning about assessment of eligibility for thrombolysis, including absolute and relative contradictions for treatment within the current licensing and likely clinical outcomes at 3 months after stroke. The graphical risk presentations can also be used.

The graphical risk presentations can also be used to develop skills in communicating benefits and risks to patients and their relatives in the acute setting. In addition, the NIHSS and dosage calculators can be used to facilitate training on assessment of stroke severity and total rt-PA dose (mg), bolus (ml), IV infusion (ml/hr) and number of 50mg rt-~PA vials needed.

The timeline function can be used to demonstrate the time dependency of treatment and the need for expeditious door to needle times.

The following screenshots and supporting explanations provide details on how COMPASS can be used within existing training and CPD for thrombolysis, including in situ on the acute stroke ward.

Green ticks (shown here) to the right of continuous variables indicate that entered values are within the current licensing criteria for thrombolysis.

Red crosses appear next to continuous variables that are invalid (absolute contraindications), and when calculate outcomes are selected a prompt to enter a valid value(s) is displayed, and it is not possible to calculate outcomes clinicians who previously expressed an interest in COMPASS.

In this example here an invalid value has been entered for time likely to treat, which would result in a calculated onset time to treatment value of > 270 mins / 4.5 hours.

When calculate outcomes is selected then a message prompting the user to enter a valid value is displayed.

In addition, the following functionality further supports learning of the current licensing criteria

Red exclamation marks indicate that entered values are out with the current licensing criteria, but they can be considered to relative contraindications.

In these cases, warning messages are displayed after selecting calculate outcomes [and variable is highlighted in red] that asks the user whether not to proceed with calculation of outcomes.

The example to the left shows an entered value for glucose that is outwith the licensing criteria and the resultant warning message is displayed.

COMPASS is hosted and managed by Pro-Quol, part of the Pro-Mapp Group.