{
  "abstract": "Background Timely endovascular therapy for acute ischemic stroke requiring interhospital transfer depends on multiple sequential workflow intervals. However, the relative contribution of each interval to overall treatment delay remains incompletely characterized. We evaluated the distribution and proportional contribution of key transfer workflow intervals to overall needle-to-groin time.Methods We conducted a retrospective study of prospectively collected registry from two comprehensive stroke centers within a unified United States stroke network. Adult patients with anterior circulation large vessel occlusion who received intravenous thrombolysis at a peripheral stroke center (PSC) within 4.5 hours of last-known-well (LKW) followed by endovascular therapy were included. Prolonged needle-to-groin (NTG) time was defined as a total NTG duration ≥ the 80th percentile of the cohort distribution. Component intervals—needle-to-PSC door-out, PSC door-out to CSC door-in, and CSC door-in to groin puncture—were examined both as absolute durations and as proportional contributions to the overall workflow time (NTG). Documented causes of delay were further classified using thematic analysis.Results Among 299 patients reviewed, 31 patients with prolonged NTG times were included. The median age was 68 years (IQR 59.5-82.5), and 45.2% were female. The median baseline NIHSS score was 17 (IQR 12-24) and the median ASPECTS was 9 (IQR 8-10). The median NTG time was 225 minutes (IQR 190.5-361.5). Among component intervals, the needle-to-PSC door-out interval accounted for the largest portion of the workflow, with a median duration of 141 minutes (IQR 87.5-178) and a median proportional contribution of 63.9% of total needle-to-groin time (IQR 36.6%-74.9%). The PSC door-out to CSC door-in interval had a median duration of 30 minutes (IQR 23-68.5), contributing 14.2% (IQR 7.0%-22.7%) of total workflow time. The median CSC door-in to groin time was 33 minutes (IQR 23.5-104), contributing 12.7% (IQR 10.4%-37.0%) of total NTG times. There was a significant difference in proportional contributions across intervals (overall p<0.001). Pairwise comparisons showed that the needle-to-PSC door-out interval contributed significantly more to total delay compared with both the PSC to CSC transfer interval (Bonferroni p < 0.001) and the CSC door-in to groin interval (Bonferroni p = 0.003).Conclusions In transferred stroke patients undergoing endovascular therapy, delays prior to departure from the primary stroke center constitute the largest contributor to overall needle-to-groin time. Efforts to improve transfer efficiency should prioritize reducing needle-to-door-out times at referring hospitals, which may yield the greatest impact on treatment timeliness.Disclosures T.M. Bielinski: None. K. Darko: None. C. Schirmer: None. O. Goren: None. P. Hendrix: None.Abstract E-223 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Geisinger Commonwealth School of Medicine, Scranton, PA"
      ],
      "name": "TM Bielinski"
    },
    {
      "affiliations": [
        "Geisinger Medical Center, Danville, PA"
      ],
      "name": "K Darko"
    },
    {
      "affiliations": [
        "Geisinger Medical Center, Danville, PA"
      ],
      "name": "C Schirmer"
    },
    {
      "affiliations": [
        "Neurosurgery, Geisinger Health, Danville, PA"
      ],
      "name": "O Goren"
    },
    {
      "affiliations": [
        "Geisinger, Danville, PA"
      ],
      "name": "P Hendrix"
    }
  ],
  "title": "E-223 Interhospital transfer delays in acute large vessel occlusion stroke: a component analysis of needle-to-groin time",
  "uid": "ca5c635c-d886-5871-820c-959625b6a28c"
}