Door-In-Door-Out Times and Functional Outcomes after Stroke in a Large Canadian Hub-and-Spoke Network
Bibliographic record
Abstract
ABSTRACT Background: The determinants of door-in-door-out metrics (DIDO) at centers referring acute ischemic stroke patients for endovascular thrombectomy (EVT) and the impact of DIDO on functional outcomes are unclear. Our primary objective was to study the association between DIDO and 90-day functional outcomes. Our secondary objective was to investigate the associations between patient clinical and workflow characteristics and DIDO. Methods: We conducted a province-wide multicentric retrospective cohort study in Québec, Canada, of adults with acute ischemic stroke who were transferred from a primary stroke center (PSC) to a comprehensive stroke center for EVT between 2017 and 2020. DIDO was calculated as the time spent in the PSC emergency department. Our co-primary outcomes, assessed 90 days after stroke, were a favorable functional outcome (modified Rankin score of 0–2) and death. We estimated associations between DIDO and co-primary outcomes and between patient characteristics and DIDO using logistic mixed models. Results: Among 790 included patients, the mean age was 69 (+/–14) years, and 400 (51%) were female. The median DIDO was 102 (80–135) minutes. DIDO was not associated with 90-day favorable functional outcome (aOR: 1.00, 95% CI [0.99–1.00], p = 0.54) or death (aOR: 1.00, 95% CI [0.99–1.01], p = 0.69). Arrival at the PSC outside daytime hours (aOR: 3.28, 95% CI [1.26–8.51], p = 0.01) was significantly associated with DIDO ≥ 60 minutes. Conclusions: Although DIDO are long in Québec, they are not associated with 90-day functional outcomes or mortality among patients transferred for EVT. Further research is required to develop strategies to improve modifiable determinants of DIDO, including workflow outside of daytime hours.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".