Door-In-Door-Out Times at Referring Hospitals and Outcomes of Hemorrhagic Stroke - 20/01/25
, Iyanuoluwa Ayodele, MS c, Brian Stamm, MD b, d, e, Brooke Alhanti, PhD c, Kevin N. Sheth, MD f, Peter Pruitt, MD, MS g, Brian Mac Grory, MB BCh c, h, William J. Meurer, MD, MS a, b, d, Shyam Prabhakaran, MD, MS iAbstract |
Study objective |
Interhospital transfer is often required in the care of patients with hemorrhagic stroke. Guidelines recommend a door-in-door-out (DIDO) time of ≤120 minutes at the transferring emergency department (ED); however, it is unknown whether DIDO times are related to clinical outcomes of hemorrhagic stroke.
Methods |
Retrospective, observational cohort study using US registry data from Get With The Guidelines–Stroke participating hospitals. Patients include those aged ≥18 years with intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) who were transferred from the ED to a Get With The Guidelines participating receiving hospital from January 1, 2019, to July 31, 2022. The primary outcome was ordinal discharge modified Rankin scale (mRS) score and secondary outcomes included dichotomous discharge mRS, ability to ambulate independently at discharge, and inhospital mortality at the receiving hospital.
Results |
In all, 19,708 ICH and 7,757 patients with SAH were included. For patients with ICH, an increasing DIDO time was associated with greater odds of mRS 0 to 3 versus 4 to 6 at discharge in the unadjusted analyses (DIDO 91 to 180 minutes, odds ratio [OR] 1.15 [1.04 to 1.27]; DIDO 181 to 270 minutes, OR 1.51 [1.33, 1.71]; DIDO >270 minutes, OR 1.83 [1.58, 2.11]; versus DIDO ≤90 minutes). In the adjusted analyses, no associations were observed. Similar results were seen for mRS at discharge in patients with SAH. In both patients with ICH and SAH, longer DIDO times were associated with greater odds of independent ambulation at discharge and lower odds of inhospital mortality in the unadjusted analyses. After adjustment, the effect sizes of these associations were reduced, with some of the results based on quartiles becoming statistically nonsignificant.
Conclusion |
These findings suggest that EDs currently expedite the transfer of the sickest patients; however, prospective studies and more granular data are needed to understand the impact of early treatment and timing of transfer for patients with hemorrhagic stroke.
Le texte complet de cet article est disponible en PDF.Plan
| Please see page 133 for the Editor’s Capsule Summary of this article. |
|
| Supervising editor: Clifton Callaway, MD, PhD. Specific detailed information about possible conflict of interest for individual editors is available at editors . |
|
| Author contributions: RR, BS, and SP conceived the study. IA, BA, and BCMG provided statistical advice on study design and analyzed the data. RR and BS drafted the manuscript. All authors contributed substantially to its revision. RR and SP take responsibility for the paper as a whole. |
|
| Data sharing statement: Data are available through application to the American Heart Association. |
|
| Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
|
| Funding and support: By Annals ’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/ ). RR receives funding from the National Institute of Health though this work was not supported by this grant. PP receives funding from the National Institutes of Health Agency for Healthcare Research and Quality. SP receives funding from the Agency for Healthcare Research and Quality and the National Institute of Neurological Disorders and Stroke and the National Heart, Lung, and Blood Institute . KNS reported grants from the National Institutes of Health, American Heart Association, Hyperfine, Biogen, and Bard; serves on the data safety monitoring board for Zoll and Sense; serves on the scientific advisory board for CSL Behring, Astrocyte, and Rhaeos; and holds equity in Alva outside the submitted work; in addition, Dr. Sheth had a patent for Alva issued. BCMG reported grants from the National Institutes of Health, American Heart Association, and Duke Office of Physician-Scientist Development outside the submitted work. WJM receives funding from the National Institutes of Health and Patient-Centered Outcomes Research Institute; however, this work was not supported by any of these grants. The remaining authors have no conflict of interest, financial or otherwise. This project was given in-kind support by the American Heart Association Hemorrhagic Stroke Data Challenge. The Get With The Guidelines–Stroke program is provided by the American Heart Association. The Get With The Guidelines–Stroke program is sponsored, in part, by Novartis, Novo Nordisk, AstraZeneca, Bayer, and HCA Healthcare. There were no external funders for this study; however, The American Heart Association provided input in the design of the study, collection, analysis, review, and approval of the manuscript for publication. |
|
| Presentation information: An abstract with a portion of the results was given as an oral presentation at the Society for Academic Emergency Medicine Annual Meeting on May 16, 2024, Phoenix, AZ. |
|
| A podcast for this article is available at www.annemergmed.com . |
|
| Readers: click on the link to go directly to a survey in which you can provide MCZBF8V to Annals on this particular article. |
Vol 85 - N° 2
P. 132-143 - février 2025 Retour au numéro
Article précédent
- Development of a Clinical Risk Score to Risk Stratify for a Serious Cause of Vertigo in Patients Presenting to the Emergency Department
- Robert Ohle, David W. Savage, Danielle Roy, Sarah McIsaac, Ravinder Singh, Daniel Lelli, Darren Tse, Peter Johns, Krishan Yadav, Jeffrey J. Perry
- In Adult Patients With Spontaneous Cervical Artery Dissection, Is Anticoagulation Associated With Reduced Risk of Ischemic Stroke When Compared With Antiplatelet Therapy?
- Steven Walton, Michael Gottlieb, Brit Long
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?