Outcome in Direct Versus Transfer Patients in the DAWN Controlled Trial

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 differenc...

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Published in:Stroke (1970) 2019-08, Vol.50 (8), p.2163-2167
Main Authors: Aghaebrahim, Amin, Jadhav, Ashutosh P, Hanel, Ricardo, Sauvageau, Eric, Granja, Manuel F, Zhang, Yanchang, Haussen, Diogo C, Budzik, Ronald F, Bonafe, Alain, Bhuva, Parita, Ribo, Marc, Cognard, Christophe, Sila, Cathy, Yavagal, Dileep, Hassan, Ameer E, Smith, Wade S, Saver, Jeffrey, Liebeskind, David S, Nogueira, Raul G, Jovin, Tudor G
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Brain Ischemia - surgery
Female
Humans
Male
Middle Aged
Patient Transfer
Stroke - surgery
Thrombectomy
Time Factors
Treatment Outcome
Triage
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Summary: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
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.119.025710