Factors associated with door-in-door-out times in large vessel occlusion stroke patients undergoing endovascular therapy.
Publication/Presentation Date
7-1-2023
Abstract
INTRODUCTION: In the management of large vessel occlusion stroke (LVOS), patients are frequently evaluated first at a non-endovascular stroke center and later transferred to an endovascular stroke center (ESC) for endovascular treatment (EVT). The door-in-door-out time (DIDO) is frequently used as a benchmark for transferring hospitals though there is no universally accepted nor evidenced-based DIDO time. The goal of this study was to identify factors affecting DIDO times in LVOS patients who ultimately underwent EVT.
METHODS: The Optimizing Prehospital Use of Stroke Systems of Care-Reacting to Changing Paradigms (OPUS-REACH) registry is comprised of all LVOS patients who underwent EVT at one of nine endovascular centers in the Northeast United States between 2015 and 2020. We queried the registry for all patients who were transferred from a non-ESC to one of the nine ESCs for EVT. Univariate analysis was performed using t-tests to obtain a p value. A priori, we defined a p value of
RESULTS: 511 patients were included in the final analysis. The mean DIDO times for all patients was 137.8 min. Vascular imaging and treatment at a non-certified stroke center were associated with longer DIDO times by 23 and 14 min, respectively. On multivariate analyses, the acquisition of vascular imaging was associated with 16 additional minutes spent at the non-ESC while presentation to a non-stroke certified hospital was associated with 20 additional minutes spent at the transferring hospital. The administration of intravenous thrombolysis (IVT) was associated with 15 min less spent at the non-ESC.
DISCUSSION: Vascular imaging and non-stroke certified stroke centers were associated with longer DIDO times. Non-ESCs should integrate vascular imaging into their workflow as feasible to reduce DIDO times. Further work examining other details regarding the transfer process such as transfer via ground or air, could help further identify opportunities to improve DIDO times.
Volume
69
First Page
87
Last Page
91
ISSN
1532-8171
Published In/Presented At
Kuc, A., Isenberg, D. L., Kraus, C. K., Ackerman, D., Sigal, A., Herres, J., Brandler, E. S., Cooney, D. R., Nomura, J. T., Mullen, M. T., Zhao, H., & Gentile, N. T. (2023). Factors associated with door-in-door-out times in large vessel occlusion stroke patients undergoing endovascular therapy. The American journal of emergency medicine, 69, 87–91. https://doi.org/10.1016/j.ajem.2023.04.009
Disciplines
Medicine and Health Sciences
PubMedID
37084482
Department(s)
Department of Emergency Medicine
Document Type
Article