The following is a summary of “Factors associated with door-in-door-out times in large vessel occlusion stroke patients undergoing endovascular therapy,” published in the July 2023 issue of Emergency Medicine by Kuc et al.

In the treatment of large vessel occlusion stroke (LVOS), patients are frequently evaluated at a non-endovascular stroke center before being transferred to an endovascular stroke center (ESC) for endovascular therapy (EVT). The door-in-door-out (DIDO) time is commonly used as a benchmark for sharing institutions, although there is neither a universally accepted nor evidence-based DIDO time. This study aimed to identify factors influencing DIDO times in patients with LVOS who ultimately underwent EVT. Between 2015 and 2020, the Optimizing Prehospital Use of Stroke Systems of Care-Reacting to Changing Paradigms (OPUS-REACH) registry included all LVOS patients who underwent EVT at one of nine endovascular centers in the Northeastern United States. 

Researchers queried the registry for all patients transferred for EVT from a hospital that was not an ESC to one of the nine ESCs. To obtain a P-value, t-tests were used to conduct univariate analysis. A priori, they deemed a P-value of <0.05 statistically significant. Multiple logistic regression was performed to determine the relationship between variables to estimate an odds ratio. There were 511 patients included in the final analysis. The average DIDO duration for all patients was 137.8 minutes. Vascular imaging and treatment at a non-certified stroke center were each associated with a 23-minute and 14-minute increase in DIDO. 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 extra minutes spent at the transferring hospital, according to multivariate analyses. 

The intravenous thrombolysis (IVT) administration was related to a 15-minute reduction in time spent at the non-ESC. Vascular imaging and centers not certified for stroke treatment were associated with prolonged DIDO times. Non-ESCs should integrate vascular imaging into their workflow as much as possible to reduce DIDO times. Additional research examining other aspects of the transfer procedure, such as ground or air transfers, could help identify further opportunities to reduce DIDO durations.

Source: sciencedirect.com/science/article/abs/pii/S073567572300195X