Abstract 27: Effect Of Automated Large Vessel Occlusion Detection On Door-in-door-out Times At Primary Stroke Centers: A Multi-center Prospective Cohort Study

Abstract

Introduction: Automated LVO detection and software-based care team integration has been shown to improve door-to-groin time metrics at comprehensive stroke centers (CSCs). The impact of this software on accelerating transfers out of primary stroke centers (PSCs) for LVO AIS patients remains undetermined. Methods: We performed a prospective cohort study across 11 stroke centers (7 PSCs and 4 CSCs) in the greater Houston area from January 1st 2021 - February 24th 2022. An automated LVO detection and workflow manager software (Viz.AI) was implemented at all the hospitals. Patients were included if they were diagnosed with LVO AIS based on CT angiogram at a PSC and were transferred to CSC. Patients who presented during a 2-week transition period at the time of LVO detection software activation were excluded. The primary outcome was time from PSC arrival to departure to CSC (door-in-door-out, DIDO) before and after software implementation and was performed using the Wilcoxon rank sum test (STATA v.15). Results: Among 234 patients that met inclusion criteria, median age was 65 [58-76] years, NIHSS 3 [1-8] and 45% were female. Mean time from last known well to PSC arrival was 512 +/- 281 minutes and mean DIDO was 176 +/- 77 min. A total of 156 patients were evaluated in the pre-software implementation period and 78 after. There were no significant differences in the pre- and post-implementation cohorts with respect to age, risk factors (HTN, HLD, Afib, carotid disease, diabetes), although a greater proportion of patients in the pre-implementation phase were female (52% vs. 31%, p<0.01). There was a significant reduction in the median DIDO time with software implementation (163 vs. 130 minutes, p=0.014). Discussion: In this multicenter cohort study, implementation of automated LVO detection with coupled care-team communication tool improved PSC transfer performance by over 30 minutes. These findings corroborate the findings for care acceleration at CSCs with similar software implementations.