{"id":24576,"date":"2023-09-01T04:18:00","date_gmt":"2023-08-31T20:18:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24576"},"modified":"2023-09-01T06:01:42","modified_gmt":"2023-08-31T22:01:42","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%8d%92%e4%b8%ad%e6%82%a3%e8%80%85%e9%99%a2%e9%99%85%e8%bd%ac%e8%bf%90%e7%9a%84%e6%97%b6%e9%97%b4","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24576","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u5352\u4e2d\u60a3\u8005\u9662\u9645\u8f6c\u8fd0\u7684\u65f6\u95f4"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

August 15, 2023<\/p>\n\n\n\n

Door-in-Door-out Times for Interhospital Transfer of Patients With Stroke<\/h1>\n\n\n\n

Brian\u00a0Stamm,\u00a0Regina\u00a0Royan,\u00a0Mihai\u00a0Giurcanu,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>2023;330(7):636-649. doi:10.1001\/jama.2023.12739<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  What is the median door-in-door-out time for interhospital transfer of patients with stroke, and what patient and hospital-level factors are associated with door-in-door-out time?<\/p>\n\n\n\n

Findings<\/strong>  In this retrospective US registry\u2013based study that included 108\u202f913 patients with acute stroke requiring interhospital transfer from 1925 hospitals, the median door-in-door-out time was 174 minutes. Age 80 years or older, female sex, Black race, and Hispanic ethnicity were significantly associated with longer door-in-door-out times, whereas emergency medical services prenotification, severe stroke, and ischemic stroke eligible for endovascular therapy were significantly associated with shorter times.<\/p>\n\n\n\n

Meaning<\/strong>  This US registry\u2013based study evaluated door-in-door-out times for patients with acute stroke requiring interhospital transfer and identified disparities and health system factors that could be possible targets for quality improvement initiatives.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Treatments for time-sensitive acute stroke are not available at every hospital, often requiring interhospital transfer. Current guidelines recommend hospitals achieve a door-in-door-out time of no more than 120 minutes at the transferring emergency department (ED).<\/p>\n\n\n\n

Objective<\/strong>  To evaluate door-in-door-out times for acute stroke transfers in the American Heart Association Get With The Guidelines-Stroke registry and to identify patient and hospital factors associated with door-in-door-out times.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  US registry\u2013based, retrospective study of patients with ischemic or hemorrhagic stroke from January 2019 through December 2021 who were transferred from the ED at registry-affiliated hospitals to other acute care hospitals.<\/p>\n\n\n\n

Exposure<\/strong>  Patient- and hospital-level characteristics.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was the door-in-door-out time (time of transfer out minus time of arrival to the transferring ED) as a continuous variable and a categorical variable (\u2264120 minutes, >120 minutes). Generalized estimating equation (GEE) regression models were used to identify patient and hospital-level characteristics associated with door-in-door-out time overall and in subgroups of patients with hemorrhagic stroke, acute ischemic stroke eligible for endovascular therapy, and acute ischemic stroke transferred for reasons other than endovascular therapy.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among 108\u202f913 patients (mean [SD] age, 66.7 [15.2] years; 71.7% non-Hispanic White; 50.6% male) transferred from 1925 hospitals, 67\u202f235 had acute ischemic stroke and 41\u202f678 had hemorrhagic stroke. Overall, the median door-in-door-out time was 174 minutes (IQR, 116-276 minutes): 29\u202f741 patients (27.3%) had a door-in-door-out time of 120 minutes or less. The factors significantly associated with longer median times were age 80 years or older (vs 18-59 years; 14.9 minutes, 95% CI, 12.3 to 17.5 minutes), female sex (5.2 minutes; 95% CI, 3.6 to 6.9 minutes), non-Hispanic Black vs non-Hispanic White (8.2 minutes, 95% CI, 5.7 to 10.8 minutes), and Hispanic ethnicity vs non-Hispanic White (5.4 minutes, 95% CI, 1.8 to 9.0 minutes). The following were significantly associated with shorter median door-in-door-out time: emergency medical services prenotification (\u221220.1 minutes; 95% CI, \u221222.1 to \u221218.1 minutes), National Institutes of Health Stroke Scale (NIHSS) score exceeding 12 vs a score of 0 to 1 (\u221266.7 minutes; 95% CI, \u221268.7 to \u221264.7 minutes), and patients with acute ischemic stroke eligible for endovascular therapy vs the hemorrhagic stroke subgroup (\u221216.8 minutes; 95% CI, \u221221.0 to \u221212.7 minutes). Among patients with acute ischemic stroke eligible for endovascular therapy, female sex, Black race, and Hispanic ethnicity were associated with a significantly higher door-in-door-out time, whereas emergency medical services prenotification, intravenous thrombolysis, and a higher NIHSS score were associated with significantly lower door-in-door-out times.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong>  In this US registry\u2013based study of interhospital transfer for acute stroke, the median door-in-door-out time was 174 minutes, which is longer than current recommendations for acute stroke transfer. Disparities and modifiable health system factors associated with longer door-in-door-out times are suitable targets for quality improvement initiatives.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  August 15, 2023 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24576"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24576"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24576\/revisions"}],"predecessor-version":[{"id":24577,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24576\/revisions\/24577"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24576"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24576"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24576"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}