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{
    "pk": 17493,
    "title": "A Shorter Door-In-Door-Out Time Is Associated with Improved Outcome in Large Vessel Occlusion Stroke",
    "subtitle": null,
    "abstract": "Introduction:\n Endovascular thrombectomy (EVT) significantly improves outcomes in large vessel occlusion stroke (LVOS). When a patient with a LVOS arrives at a hospital that does not perform EVT, emergent transfer to an endovascular stroke center (ESC) is required. Our objective was to determine the association between door-in-door-out time (DIDO) and 90-day outcomes in patients undergoing EVT.\nMethods:\n We conducted an analysis of the Optimizing Prehospital Stroke Systems of Care-Reacting to Changing Paradigms (OPUS-REACH) registry of 2,400 LVOS patients treated at nine ESCs in the United States. We examined the association between DIDO times and 90-day outcomes as measured by the modified Rankin scale.\nResults:\n A total of 435 patients were included in the final analysis. The mean DIDO time for patients with good outcomes was 17 minute shorter than patients with poor outcomes (122 minutes [min] vs 139 min, P = 0.04). Absolute DIDO cutoff times of ≤60 min, ≤90 min, or ≤120 min were not associated with improved functional outcomes (46.4 vs 32.3%, P = 0.12; 38.6 vs 30.6%, P = 0.10; and 36.4 vs 28.9%, P = 0.10, respectively). This held true for patients with hyperacute strokes of less than four-hour onset. Lower baseline National Institutes of Health Stroke Scale (NIHSS) score (11.9 vs 18.2, P =<.001) and younger age (62.5 vs 74.9 years (P < .001) were associated with improved outcomes. On multiple regression analysis, age (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.45–2.02) and baseline NIHSS score (OR 1.67, 95% CI 1.42–1.98) were associated with improved outcomes while DIDO time was not associated with better outcome (OR 1.13, 95% CI 0.99–1.30).\nConclusion: \nAlthough the DIDO time was shorter for patients with a good outcome, this was non-significant in multiple regression analysis. Receipt of intravenous thrombolysis and time to EVT were not associated with better outcomes, while male gender, lower age, arrival by private vehicle, and lower NIHSS score portended better outcomes. No absolute DIDO-time cutoff or modifiable factor was associated with improved outcomes for LVOS. This study underscores the need to streamline DIDO times but not to set an artificial DIDO time benchmark to meet.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "neurology, stroke, large vessel occlusion stroke, thrombectomy, door-in-door-out time"
        }
    ],
    "section": "Neurology",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/2dq931xc",
    "frozenauthors": [
        {
            "first_name": "Adam",
            "middle_name": "",
            "last_name": "Sigal",
            "name_suffix": "",
            "institution": "Reading Hospital, Department of Emergency Medicine, West Reading, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Derek",
            "middle_name": "L.",
            "last_name": "Isenberg",
            "name_suffix": "",
            "institution": "Lewis Katz School of Medicine at Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Chadd",
            "middle_name": "K.",
            "last_name": "Kraus",
            "name_suffix": "",
            "institution": "Geisinger Health, Department of Emergency Medicine, Danville, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Daniel",
            "middle_name": "",
            "last_name": "Ackerman",
            "name_suffix": "",
            "institution": "St. Luke’s Health System, Department of Neurology, Bethlehem, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Joseph",
            "middle_name": "",
            "last_name": "Herres",
            "name_suffix": "",
            "institution": "Einstein Health System, Department of Emergency Medicine, Philadelphia, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Ethan",
            "middle_name": "S.",
            "last_name": "Brandler",
            "name_suffix": "",
            "institution": "State University of New York-Stony Brook, Department of Emergency Medicine, Stony Brook, New York",
            "department": "None"
        },
        {
            "first_name": "Alexander",
            "middle_name": "",
            "last_name": "Kuc",
            "name_suffix": "",
            "institution": "Cooper University Healthcare, Department of Emergency Medicine, Camden, New Jersey",
            "department": "None"
        },
        {
            "first_name": "Jason",
            "middle_name": "T.",
            "last_name": "Nomura",
            "name_suffix": "",
            "institution": "Christiana Care, Department of Emergency, Newark, Delaware",
            "department": "None"
        },
        {
            "first_name": "Derek",
            "middle_name": "R.",
            "last_name": "Cooney",
            "name_suffix": "",
            "institution": "State University of New York-Upstate, Department of Emergency Medicine, Syracuse, New York",
            "department": "None"
        },
        {
            "first_name": "Michael",
            "middle_name": "T.",
            "last_name": "Mullin",
            "name_suffix": "",
            "institution": "Lewis Katz School of Medicine at Temple University, Department of Neurology, Philadelphia, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Huaquing",
            "middle_name": "",
            "last_name": "Zhao",
            "name_suffix": "",
            "institution": "Lewis Katz School of Medicine at Temple University, Center for Biostatistics and Epidemiology, Philadelphia, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Nina",
            "middle_name": "T.",
            "last_name": "Gentile",
            "name_suffix": "",
            "institution": "Lewis Katz School of Medicine at Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania",
            "department": "None"
        }
    ],
    "date_submitted": "2022-09-20T20:55:39Z",
    "date_accepted": "2022-09-20T20:55:39Z",
    "date_published": "2023-08-30T20:22:26Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/17493/galley/8916/download/"
        }
    ]
}