Outcome in Direct Versus Transfer Patients in the DAWN Controlled Trial
| Autor: | Marc Ribó, Dileep R. Yavagal, Raul G Nogueira, Ricardo A. Hanel, Yanchang Zhang, Christophe Cognard, Cathy A. Sila, Eric Sauvageau, Ashutosh P Jadhav, Parita Bhuva, Manuel F Granja, Jeffrey L. Saver, Ronald F. Budzik, Amin Aghaebrahim, Alain Bonafe, Diogo C Haussen, David S Liebeskind, Tudor G Jovin, Wade S. Smith, Ameer E Hassan |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Patient Transfer Time Factors Population 030204 cardiovascular system & hematology Brain Ischemia law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Interquartile range law Modified Rankin Scale Clinical endpoint Humans Medicine education Stroke Aged Thrombectomy Aged 80 and over Advanced and Specialized Nursing education.field_of_study business.industry Odds ratio Middle Aged medicine.disease Triage Treatment Outcome Anesthesia Female Neurology (clinical) Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | Stroke. 50:2163-2167 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.119.025710 |
| Popis: | Background and Purpose— The impact of transfer status on clinical outcomes in the DAWN (DWI or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo) population is unknown. We analyzed workflow and clinical outcome differences between direct versus transfer patients in the DAWN population. Methods— The following time metrics were analyzed for each group: (1) last known well to hospital arrival, (2) hospital arrival to eligibility imaging, (3) hospital arrival to arterial puncture, (4) qualifying imaging to arterial puncture, (5) last known well to arterial puncture, (6) last known well to reperfusion. The primary end point was the rate of functional independence (90-day modified Rankin Scale [mRS] score, 0–2). Using univariate unconditional logistic regression, we calculated odds ratios and 95% CIs for the association between clinically relevant time metrics, transfer status, and functional independence (mRS 0–2). Results— A total of 206 patients were enrolled. Among these, 121 (59%) patients were transferred, and 85 (41%) patients presented directly to a thrombectomy capable center. Median time last seen well to hospital arrival time was similar between the 2 groups (678 versus 696 minutes). The time from hospital arrival to groin puncture was significantly longer in direct patients compared with transferred patients 140 minutes (interquartile range, 105.5–177.5 minutes) and 88 minutes (interquartile range, 55–125 minutes), respectively ( P P =0.817). Conclusions— Although transfer patients had a faster door to puncture time, benefits of thrombectomy, and rates of mRS 0 to 2 in the treatment group were similar between direct and transferred patients in the DAWN population. These results may inform prehospital and primary stroke centers triage protocols in patients presenting in the late time window. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT02142283. |
| Databáze: | OpenAIRE |
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