Abstract WP98: Temporal Trends and Predictors of Door-in-Door-out Times for Interhospital Stroke Transfers in the Greater Cincinnati Northern Kentucky Stroke Study

• DOI: 10.1161/str.56.suppl_1.wp98
• Publication Date: 2025-01-30T10:27:49Z
• Authors: Brian Stamm; Regina Royan; Lili Ding; David Robinson; Mary Haverbusch; Simona Ferioli; Robert Stanton; Yasmin Aziz; Joseph LaPorta; Daniel Woo; Paul Wechsler; Lauren Menzies; Shea Wright; Lisa Nobel; Sabreena Slavin; Kyle Walsh; Felipe DeLosRiosL...; Jason Mackey; Eva Mistry; Stacie Demel; Elisheva Coleman; Adam Jasne; Michael Star; Sharyl Martini; Opeolu Adeoye; Matthew Flaherty; Pooja Khatri; Tracy Madsen; Joseph Broderick; Brett Kissela; Dawn Kleindorfer
• Keywords: Stroke

Introduction: Acute treatment for stroke often requires emergent interhospital transfer access to advanced therapies not available at the initial hospital. Prolonged times have been associated with worse outcomes. Door-in-door-out time (DIDO: amount of a patient spends in transferring emergency department [ED]) is an important quality metric acute care, current recommendations DIDO ≤ 120 minutes. We sought characterize trends and predictors transfers using Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS). Methods: utilized data from GCNKSS, population-based epidemiologic study, following points: 1999, 2005, 2010, 2015, 2020. Patients ≥18 years ischemic (AIS) or hemorrhagic (HS) who presented ED were admitted but transferred another hospital included. The primary outcome was time. Temporal tested Mann-Kendall trend test. Generalized linear mixed effects models hospital-specific random intercepts constructed evaluate associations between patient- hospital-level covariates Results: Of 13,678 cases over periods studied, 1574 patients met inclusion criteria overall group (mean age 64.7 [SD: 15.6], 51.6% female), 851 (54.1%) having AIS 723 (45.9%) HS. Over examined, median 213 minutes (IQR 142-305), significantly increased (Figure 1; P<.0001). In group, factors explained 4.0% variation multiple regression model, included: history prior (+33.6 minutes; P<.0001) receipt MRI (+165.7 P<.0001); whereas EMS transport (-30.0 P<.001) increasing NIHSS score (P<.0001) decreased Results similar HS subgroups (Table 2). Conclusions: this exceeded recommended targets Hospital-level accounted only minor proportion times, suggesting that future improvement efforts should target modifiable clinical systems improve times.