TY - JOUR
T1 - Determinants of door-in-door-out time in patients with ischaemic stroke transferred for endovascular thrombectomy
AU - van de Wijdeven, Ruben M.
AU - Duvekot, Martijne H. C.
AU - van der Geest, Patrick J.
AU - Moudrous, Walid
AU - Dorresteijn, Kirsten R. IS
AU - Wijnhoud, Annemarie D.
AU - Mulder, Laus J. MM
AU - Alblas, Kees C. L.
AU - Asahaad, Nabil
AU - Kerkhoff, Henk
AU - Dippel, Diederik W. J.
AU - Roozenbeek, Bob
N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Dutch Heart Foundation (grant 2021T077). Funding Information: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Diederik Dippel reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. Bob Roozenbeek reports funding from the Dutch Heart Foundation and The Netherlands Organisation for Health Research and Development, all paid to institution. All other authors declare no conflict of interest. Publisher Copyright: © European Stroke Organisation 2023.
PY - 2023/9
Y1 - 2023/9
N2 - Background: Long door-in-door-out (DIDO) times are an important cause of treatment delay in patients transferred for endovascular thrombectomy (EVT) from primary stroke centres (PSC) to an intervention centre. Insight in causes of prolonged DIDO times may facilitate process improvement interventions. We aimed to quantify different components of DIDO time and to identify determinants of DIDO time. Methods: We performed a retrospective cohort study in a Dutch ambulance region consisting of six PSCs and one intervention centre. We included consecutive adult patients with anterior circulation large vessel occlusion, transferred from a PSC for EVT between October 1, 2019 and November 31, 2020. We subdivided DIDO into several time components and quantified contribution of these components to DIDO time. We used univariable and multivariable linear regression models to explore associations between potential determinants and DIDO time. Results: We included 133 patients. Median (IQR) DIDO time was 66 (52–83) min. The longest component was CTA-to-ambulance notification time with a median (IQR) of 24 (16–37) min. DIDO time increased with age (6 min per 10 years, 95% CI: 2–9), onset-to-door time outside 6 h (20 min, 95% CI: 5–35), M2-segment occlusion (15 min, 95% CI: 4–26) and right-sided ischaemia (12 min, 95% CI: 2–21). Conclusions: The CTA-to-ambulance notification time is the largest contributor to DIDO time. Higher age, onset-to-door time longer than 6 h, M2-segment occlusion and right-sided occlusions are independently associated with a longer DIDO time. Future interventions that aim to decrease DIDO time should take these findings into account.
AB - Background: Long door-in-door-out (DIDO) times are an important cause of treatment delay in patients transferred for endovascular thrombectomy (EVT) from primary stroke centres (PSC) to an intervention centre. Insight in causes of prolonged DIDO times may facilitate process improvement interventions. We aimed to quantify different components of DIDO time and to identify determinants of DIDO time. Methods: We performed a retrospective cohort study in a Dutch ambulance region consisting of six PSCs and one intervention centre. We included consecutive adult patients with anterior circulation large vessel occlusion, transferred from a PSC for EVT between October 1, 2019 and November 31, 2020. We subdivided DIDO into several time components and quantified contribution of these components to DIDO time. We used univariable and multivariable linear regression models to explore associations between potential determinants and DIDO time. Results: We included 133 patients. Median (IQR) DIDO time was 66 (52–83) min. The longest component was CTA-to-ambulance notification time with a median (IQR) of 24 (16–37) min. DIDO time increased with age (6 min per 10 years, 95% CI: 2–9), onset-to-door time outside 6 h (20 min, 95% CI: 5–35), M2-segment occlusion (15 min, 95% CI: 4–26) and right-sided ischaemia (12 min, 95% CI: 2–21). Conclusions: The CTA-to-ambulance notification time is the largest contributor to DIDO time. Higher age, onset-to-door time longer than 6 h, M2-segment occlusion and right-sided occlusions are independently associated with a longer DIDO time. Future interventions that aim to decrease DIDO time should take these findings into account.
KW - Ischaemic stroke
KW - door-in-door-out time
KW - endovascular thrombectomy
KW - hospital workflow
UR - http://www.scopus.com/inward/record.url?scp=85162965865&partnerID=8YFLogxK
U2 - https://doi.org/10.1177/23969873231177768
DO - https://doi.org/10.1177/23969873231177768
M3 - Article
C2 - 37248995
SN - 2396-9873
VL - 8
SP - 667
EP - 674
JO - European Stroke Journal
JF - European Stroke Journal
IS - 3
ER -