Study objective

Acute stroke patients often require interfacility transfer from primary stroke centers to comprehensive stroke centers. Given the time-sensitive benefits of endovascular reperfusion, reducing door-in-door-out time at the primary stroke center is a target for quality improvement. We sought to identify modifiable predictors of door-in-door-out times at 3 Chicago-region primary stroke centers.

Methods

We performed a retrospective analysis of consecutive patients with acute stroke from February 1, 2018 to January 31, 2020 who required transfer from 1 of 3 primary stroke centers to 1 of 3 affiliated comprehensive stroke centers in the Chicago region. Stroke coordinators at each primary stroke center abstracted data on type of transport, medical interventions and treatments prior to transfer, and relevant time intervals from patient arrival to departure. We evaluated predictors of door-in-door-out time using median regression models.

Results

Of 191 total patients, 67.9% arrived by emergency medical services and 57.4% during off-hours. Telestroke was performed in 84.2%, 30.5% received alteplase, and 48.4% underwent a computed tomography (CT) angiography at the primary stroke center. The median door-in-door-out time was 148.5 (interquartile range 106 to 207.8) minutes. The largest contributors to door-in-door-out time, in minutes, were CT to CT angiography time (22 [7 to 73.5]), transfer center contact to ambulance request time (20 [8 to 53.3]), ambulance request to arrival time (20.5 [14 to 36]), and transfer ambulance time at primary stroke center (26 [21 to 35]). Factors associated with door-in-door-out time were (adjusted median differences, in minutes [95% confidence intervals]): CT angiography performed at primary stroke center (+39 [12.3 to 65.7]), walk-in arrival mode (+53 [4.1 to 101.9]), administration of intravenous alteplase (-29 [-31.3 to -26.7]), intubation at primary stroke center (+23 [7.3 to 38.7]), and ambulance request by primary stroke center (-20 [-34.3 to -5.7]).

Conclusion

Door-in-door-out times at Chicago-area primary stroke centers average nearly 150 minutes. Reducing time to CT angiography, receipt of alteplase, and ambulance request are likely important modifiable targets for interventions to decrease door-in-door-out times at primary stroke centers.

中文翻译：

---

芝加哥初级卒中中心的门中门外处理时间

学习目标

急性卒中患者通常需要从初级卒中中心转移到综合卒中中心。鉴于血管内再灌注的时间敏感性优势，减少主要卒中中心的门到门时间是质量改进的目标。我们试图在芝加哥地区的 3 个初级卒中中心确定可修改的门中门外出时间预测因素。

方法

我们对 2018 年 2 月 1 日至 2020 年 1 月 31 日的连续急性卒中患者进行了回顾性分析，这些患者需要从芝加哥地区 3 个主要卒中中心中的 1 个转移到 3 个附属综合卒中中心中的 1 个。每个初级卒中中心的卒中协调员提取有关转运类型、转移前的医疗干预和治疗以及从患者到达到离开的相关时间间隔的数据。我们使用中值回归模型评估了进门时间的预测因素。

结果

在 191 名患者中，67.9% 是通过紧急医疗服务到达的，57.4% 是在非工作时间到达的。84.2% 的患者接受了电击，30.5% 的患者接受了阿替普酶治疗，48.4% 的患者在主要卒中中心接受了计算机断层扫描 (CT) 血管造影术。中位门进门出时间为 148.5（四分位距 106 至 207.8）分钟。以分钟为单位的门到门时间的最大贡献者是 CT 到 CT 血管造影时间（22 [7 到 73.5]）、转移中心联系到救护车请求时间（20 [8 到 53.3]）、救护车请求到到达时间（20.5 [14 至 36]），以及在主要卒中中心转移救护车的时间（26 [21 至 35]）。与门到门出门时间相关的因素是（调整后的中位数差异，以分钟为单位 [95% 置信区间]）：在初级卒中中心进行的 CT 血管造影（+39 [12.3 至 65.7]）、步入式到达模式（ +53 [4.

结论

芝加哥地区初级卒中中心的门到门外出时间平均接近 150 分钟。减少 CT 血管造影的时间、接受阿替普酶和救护车可能是干预措施的重要可修改目标，以减少初级卒中中心的进门出院时间。