Discussion
90-day disability
In this prospective cluster randomized trial of nearly 250 patients with LVO AIS presenting to emergency departments and treated with EVT across 4 CSCs, activation of AI-enabled LVO alerts resulted in an 11-minute reduction in DTG time. Time from CT initiation to EVT start fell by a similar amount and rates of mortality fell by nearly 60%. We did not observe significant differences in hospital length of stay, discharge, or 90-day functional outcomes.Prior studies have examined the effect of automated LVO detection on in-hospital quality metrics, as well as clinical outcomes. Several studies have found statistically significant reductions in DTG time and one study identified a reduction in hospital length of stay.There are several mechanisms by which DTG reduction could have occurred in this study. First, the automated LVO alert arrives within minutes of CTA completion, far earlier than human interpretation, and in many cases even before the CTA images were available for review on the clinical PACS. In addition, the process for screening, evaluating, and ultimately treating a patient with EVT can be highly complicated with many different care teams that need to work in synchrony. Prior studies have shown that organizing this process into a parallel workflow, rather than serial, can improve DTG times.We did not observe any improvements in 90-day disability outcomes or in length of stay associated with the intervention. Likelihood of good outcome is known to deteriorate with delays in EVT, and in some series, statistically significant improvements in mRS could be seen with 15-minute accelerations in care.