Impact of prehospital scene-to-door time on functional outcomes after endovascular thrombectomy: insights from a regional stroke network
4 affiliations
- 1Department of Neurosurgery, St. Mary’s Hospital
- 2Department of Cerebrovascular Medicine, St. Mary’s Hospital
- 3Research Center, St. Mary’s Hospital
- 4Faculty of Nursing, St. Mary’s College
Abstract
Background Minimizing time to endovascular thrombectomy (EVT) is crucial for the treatment of acute ischemic stroke (AIS). While prehospital transport interval is widely used to describe the overall ambulance transfer process, the prognostic relevance of scene-to-door time (SDT)—the interval from departure at the emergency scene to hospital arrival—remains unclear. This study aimed to examine the association between SDT and 90-day functional outcomes after EVT, with focus on the modifying role of pre-stroke disability. Methods We retrospectively analyzed patients who underwent EVT at a single comprehensive stroke center between 2018 and 2023. Time metrics, including the onset-to-door time, onset-to-recanalization time, and SDT, were collected. Pre-stroke disability (modified Rankin Scale [mRS] ≥ 1) was assessed as a potential effect modifier. The receiver operating characteristic (ROC) curve was analyzed to determine the discriminative ability of SDT for 90-day favorable clinical outcome (mRS ≤ 3). Results Of the 176 patients who underwent EVT for AIS during the study period, 121 were directly transported from the scene and included in the final analysis. In the overall direct-transport cohort, SDT showed a modest but non-significant association with favorable clinical outcomes (area under the curve [AUC] = 0.57). In patients with pre-stroke disability, SDT demonstrated moderate discrimination (AUC = 0.76) with an optimal cutoff of 14 min. In multivariable logistic regression analyses adjusted for age, sex, baseline National Institutes of Health Stroke Scale (NIHSS), and use of intravenous thrombolysis (IVT), increasing SDT was independently associated with lower odds of favorable clinical outcomes in patients with pre-stroke disability (adjusted odds ratio 0.91, 95% confidence interval 0.81–0.98). Conclusions SDT showed limited discriminative performance for functional outcomes across the overall EVT cohort but demonstrated moderate discrimination among patients with pre-stroke disability. SDT may reflect certain aspects of regional transport efficiency within stroke care systems.
Related
- Apparent Diffusion Coefficient Composition and Tissue Heterogeneity as Predictors of Functional Outcomes After Endovascular Thrombectomy in Patients With Large Ischemic Core
- Functional outcomes and quality of life after endovascular thrombectomy in large and extensive infarcts (ASPECTS 0-5): a multicentre registry study.
- Five-Day Glycemic Patterns and 3-Month Functional Outcomes After Endovascular Thrombectomy.
- Association Between Hypoperfusion Intensity Ratio and Outcomes After Endovascular Thrombectomy in Posterior Circulation Stroke: A Retrospective Study
- Association of Estimated Arterial Stiffness with Collateral Status and Functional Outcome after Endovascular Thrombectomy: A Secondary Analysis of the OPTIMAL-BP Trial
BibTeX
@article{matsumoto2026impact,
title = {{Impact of prehospital scene-to-door time on functional outcomes after endovascular thrombectomy: insights from a regional stroke network}},
author = {Yoshihisa Matsumoto and Kenji Fukuda and Yuka Kawahara and Chiyo Tsutsumi and Yuichiro Ide and Kenji Takahashi and Tomonaga Matsushita and Tomohiko Nitta and Shinji Kitsuki and Yasushi Okada},
journal = {BMC Emergency Medicine},
year = {2026},
month = jul,
doi = {10.1186/s12873-026-01706-5},
url = {https://doi.org/10.1186/s12873-026-01706-5},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of prehospital scene-to-door time on functional outcomes after endovascular thrombectomy: insights from a regional stroke network
AU - Yoshihisa Matsumoto
AU - Kenji Fukuda
AU - Yuka Kawahara
AU - Chiyo Tsutsumi
AU - Yuichiro Ide
AU - Kenji Takahashi
AU - Tomonaga Matsushita
AU - Tomohiko Nitta
AU - Shinji Kitsuki
AU - Yasushi Okada
PY - 2026
DA - 2026/07/01
JO - BMC Emergency Medicine
DO - 10.1186/s12873-026-01706-5
UR - https://doi.org/10.1186/s12873-026-01706-5
AB - Background Minimizing time to endovascular thrombectomy (EVT) is crucial for the treatment of acute ischemic stroke (AIS). While prehospital transport interval is widely used to describe the overall ambulance transfer process, the prognostic relevance of scene-to-door time (SDT)—the interval from departure at the emergency scene to hospital arrival—remains unclear. This study aimed to examine the association between SDT and 90-day functional outcomes after EVT, with focus on the modifying role of pre-stroke disability. Methods We retrospectively analyzed patients who underwent EVT at a single comprehensive stroke center between 2018 and 2023. Time metrics, including the onset-to-door time, onset-to-recanalization time, and SDT, were collected. Pre-stroke disability (modified Rankin Scale [mRS] ≥ 1) was assessed as a potential effect modifier. The receiver operating characteristic (ROC) curve was analyzed to determine the discriminative ability of SDT for 90-day favorable clinical outcome (mRS ≤ 3). Results Of the 176 patients who underwent EVT for AIS during the study period, 121 were directly transported from the scene and included in the final analysis. In the overall direct-transport cohort, SDT showed a modest but non-significant association with favorable clinical outcomes (area under the curve [AUC] = 0.57). In patients with pre-stroke disability, SDT demonstrated moderate discrimination (AUC = 0.76) with an optimal cutoff of 14 min. In multivariable logistic regression analyses adjusted for age, sex, baseline National Institutes of Health Stroke Scale (NIHSS), and use of intravenous thrombolysis (IVT), increasing SDT was independently associated with lower odds of favorable clinical outcomes in patients with pre-stroke disability (adjusted odds ratio 0.91, 95% confidence interval 0.81–0.98). Conclusions SDT showed limited discriminative performance for functional outcomes across the overall EVT cohort but demonstrated moderate discrimination among patients with pre-stroke disability. SDT may reflect certain aspects of regional transport efficiency within stroke care systems.
SN - 1471-227X
ER -