Door In Door Out Time At Primary Stroke Centers Predicts Outcome For Patients With Large Vessel Occlusion Stroke

Introduction: We have previously shown that a transfer protocol for patients with suspected large vessel occlusion (LVO) stroke which includes early vessel imaging at the Primary Stroke Center (PSC) is associated with decreased onset to recanalization times driven entirely by improved initial hospital processes at the PSC and reflected in the PSC Door-in Door-out (DIDO) time. In this study, we examined the association between DIDO and outcomes. Methods: We collected prospective data on 195 patients transferred to our Comprehensive Stroke Center (CSC) with PSC-confirmed LVO between July 1, 2015 and June 30, 2017. The patients were accepted from 2 states and 16 different PSCs (only 2 of which were part of our hospital system) and the furthest PSC being 56 miles away. We included all patients with LVO stroke (ICA, M1, Basilar) with an NIHSS of 6 or higher. We examined PSC workflow factors associated with shorter DIDO times. Outcomes were examined by DIDO using generalized mix modeling assuming a binomial dis...