Clinical Research
Association of door-in-door-out time with clinical outcomes in patients with acute large vessel occlusion stroke of anterior circulation after early endovascular therapy
Wu Kangfei, Huang Chengzhou, Guo Yapeng, Xu Junfeng, Sun Yi, Ji Yachen, Wang Hao, Zhou Zhiming, Huang Xianjun, Yang Qian
Published 2023-12-08
Cite as Chin J Neurol, 2023, 56(12): 1371-1380. DOI: 10.3760/cma.j.cn113694-20230912-00150
Abstract
ObjectiveTo investigate the association between door-in-door-out time (DIDO) and clinical outcome of patients with acute large vessel occlusion stroke (AIS-LVO) of anterior circulation after early endovascular therapy (EVT).
MethodsThe patients with AIS-LVO of anterior circulation who received EVT in the advanced stroke center of the Yijishan Hospital of Wannan Medical College from February 2019 to December 2021 were retrospectively analyzed. The baseline characteristics, time metrics and clinical outcomes were collected. DIDO was defined as the duration of time from arrival to referral at the primary stroke center, and the primary outcome was favorable clinical outcome, as evaluated by a modified Rankin Scale score of 0 to 2 at 3 months after EVT. Univariate and multivariate regression analysis was used to explore the relationship between DIDO and early endovascular treatment clinical outcomes in patients with AIS-LVO.
ResultsA total of 320 patients [aged (69.6±10.2) years] were enrolled. The baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program early CT score were 14 (11, 18) and 8 (7, 9). The DIDO time was 76 (50, 120) minutes. DIDO was not an independent correlation factor for clinical outcomes in patients with EVT in the overall population. However, in patients receiving early EVT (onset-to-reperfusion≤300 minutes), DIDO (OR=1.030, 95%CI 1.001-1.059, P=0.041) was an independent correlating factor of clinical outcome in patients with EVT. According to the receiver operating characteristic curve, the DIDO cutoff of 74.5 minutes can be used as an important indicator of prehospital delay in referral to EVT for large vascular occlusion stroke. Door to computed tomography time (OR=1.393, 95%CI 1.212-1.601, P<0.001) and computed tomography to transfer time (OR=1.386, 95%CI 1.220-1.575, P<0.001) were factors associated with DIDO≤74.5 minutes in a multivariate analysis in this time frame.
ConclusionsIn transferred patients undergoing EVT early, DIDO has a signifificant impact on clinical outcome. DIDO can be used as an important quality control indicator to evaluate the referral process for patients with AIS-LVO.
Key words:
Stroke; Arterial occlusive diseases; Patient transfer; Prognosis; Endovascular treatment
Contributor Information
Wu Kangfei
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China
Huang Chengzhou
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China
Guo Yapeng
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China
Xu Junfeng
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China
Sun Yi
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China
Ji Yachen
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China
Wang Hao
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China
Zhou Zhiming
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China
Huang Xianjun
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China
Yang Qian
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China
