Abstract
Introduction: Quality metrics for thrombectomy measure timeliness of treatment using door-to-puncture time. Due to the different modes of patient presentation, “door” time may herald anything from the arrival of an undifferentiated patient in need of complete clinical, radiological, and serological evaluation, to a differentiated patient in need of no additional workup. Thus, there is potentially great variation in “door-to-puncture” time between these groups even in the face of similar stroke team performance. In this work, we propose an alternative metric, “endovascular go”-to-puncture time, that is more consistent across modes of presentation. Methods: Clinical data for thrombectomies at our hospital between January 2015 and June 2018 were contemporaneously recorded by clinical nurses and data analysts. Patients were classified as “ED” if they presented initially to our hospital, “Transfer” if they presented initially to another hospital, and “Inpatient” if they were inpatients in our hospital at the time of stroke onset. Door time was defined as the time of patient arrival to our ED, or for inpatients, the time of stroke onset. “Endovascular go” time was defined as the later of door time or time of neuroimaging completion. Puncture time was defined as the time of first skin puncture. Results: Median door-to-puncture time was 86 mins for ED patients, 51 mins for transfer patients, and 136 mins for inpatients (Table). Median “endovascular go”-to-puncture time was 63 mins for ED patients, 43 mins for transfer patients, and 69 mins for inpatients. Across all patients, SD of door-to-puncture time was 81 mins, compared to SD of “Endovascular Go”-to-puncture time, which was 23 mins. Conclusions: For thrombectomy patients, “endovascular go”-to-puncture time is more consistent across different presentation modes than the conventional door-to-puncture time. This metric may allow for simplified quality guidelines that apply to all modes of presentation. Table:
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
