Abstract Details

Title Door-In to Door-Out time in Emergent Large Vessel Occlusion: retrospective review informs targeted improvement strategies

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 4-009

Objective We sought to characterize predictors, components and variability of Door-In to Door-Out (DIDO) time, to inform strategies to optimize triage of patients with Emergent Large Vessel Occlusion (ELVO).

Background In patients with ELVO, hub and spoke stroke network require rapid interfacility transfers from Primary Stroke Centers (PSC) to a Comprehensive Stroke Center (CSC). DIDO time at PSC is an emerging performance measure and modifiable factor in time to thrombectomy that affects clinical outcome. DIDO time has been associated with CT angiography (CTA) at PSC, but no other clinical predictors have been described so far.

Design/Methods We reviewed transfers for CT perfusion or thrombectomy from 4 PSCs to a CSC between 1/2017 and 6/2019. We excluded predefined scenarios expected to introduce a delay. We used multiple regression analysis to identify independent predictors of log-transformed DIDO time among many clinical, imaging and logistic factors.

Results

Fifty-eight persons were included, of which 30 were male, 28 received IV tPA, 20 had hyperdense MCA sign on initial CT, 18 had CTA at PSC. Median for age, NIHSS, door-to-needle time, and DIDO were 73 years, 17 points, 37 and 94 minutes, respectively.
Hyperdense MCA sign on initial CT, CTA at PSC, and spoke site independently predicted DIDO time, with standardized beta and significance of -.386 and .001, .486 and .000, -.248 and 0.035, respectively. This model predicted 34% of variability in DIDO time.
Median (interquartile difference) for transfer-acceptance-to-door-out time and CTA-completion-to-interpretation time were 32 (18) and 17 (28) minutes.

Conclusions

Hyperdense MCA sign is a novel independent predictor of shorter DIDO time. High variability in intervals not requiring clinical decision making (CTA-initiation-to-interpretation time, and Decision-to-Door-Out time) makes them excellent targets for standardization. Early contact with CSC, early CTA initiation and interpretation, ambulance remaining in proximity to PSC and rapid discharge process may expedite triage in ELVO patients.

Authors/Disclosures
Marek Cierny, MD (Medical College of Wisconsin) PRESENTER	No disclosure on file
	No disclosure on file
Marc A. Lazzaro, MD	No disclosure on file

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