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Updated: Jul 30, 2026

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
09:52

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Published on: January 15, 2017

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Door-In-Door-Out Times and Functional Outcomes after Stroke in a Large Canadian Hub-and-Spoke Network

Aymen Sahal, Joel Neves Briard, Leila Azzi

    The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
    |April 13, 2025
    PubMed

    Insights

    Door-in-door-out metrics (DIDO) for acute ischemic stroke patients undergoing endovascular thrombectomy (EVT) were not linked to 90-day functional outcomes or death. Improving workflow outside daytime hours may reduce DIDO at primary stroke centers.

    Area of Science:

    • Neurology
    • Public Health
    • Health Services Research

    Background:

    • Door-in-door-out (DIDO) metrics for acute ischemic stroke patients undergoing endovascular thrombectomy (EVT) and their impact on outcomes are not well understood.
    • Investigating DIDO determinants and their association with functional outcomes is crucial for stroke care optimization.

    Purpose of the Study:

    • To examine the association between DIDO and 90-day functional outcomes in acute ischemic stroke patients transferred for EVT.
    • To identify patient clinical and workflow characteristics associated with DIDO.

    Main Methods:

    • Retrospective, province-wide cohort study of 790 acute ischemic stroke patients transferred for EVT in Québec, Canada (2017-2020).
    • DIDO calculated as time spent in the primary stroke center (PSC) emergency department.
    • Logistic mixed models used to assess associations between DIDO, functional outcomes (modified Rankin score 0-2, death at 90 days), and patient characteristics.

    Main Results:

    • Median DIDO was 102 minutes; no significant association found between DIDO and 90-day favorable functional outcome or death.
    • Arrival at the PSC outside daytime hours was significantly associated with longer DIDO (≥ 60 minutes).

    Conclusions:

    • Long DIDO times in Québec do not appear to impact 90-day functional outcomes or mortality for EVT transfer patients.
    • Further research needed to identify and improve modifiable determinants of DIDO, particularly concerning off-hours workflow.
    Abstract

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