Abstract
Objective
The optimal patient transportation destination of acute ischemic stroke (AIS) patients
remains uncertain. The purpose of this study was to evaluate the predictive variables
that determine stroke outcomes depending on the patient transportation destination.
Methods
We performed a retrospective study using an AIS database consisting of patients who
underwent thrombectomy admitted to our institution from November 1, 2011, through
October 1, 2018.
Results
A total of 171 patients were included in the statistical analysis; 42.1% (72/171)
of patients were in the mothership group (directly admitted) and 57.9% (99/171) in
the drip-and-ship group (transferred). Multivariable logistic regression revealed
the predictive factors for favorable outcomes were driving distance (expressed in
miles) between the patient's home and a comprehensive stroke center (CSC) (odds ratio
[OR] = 0.95; 95% confidence interval [CI], 0.90-0.99; P = .035), absence of diabetes mellitus (OR = 3.60; 95% CI, 1.20-10.82; P = .022), lower National Institutes of Health Stroke Scale score at admission (OR = 0.91;
95% CI, 0.85-0.97; P = .003), and shorter symptom onset to CSC arrival time (expressed in hours) (OR = 0.84;
95% CI, 0.72-0.99; P = .038).
Conclusions
Our study revealed that a shorter driving distance between the patient's home and
CSC, absence of diabetes, lower National Institutes of Health Stroke Scale score,
and shorter onset to hospital arrival time positively impacted the outcomes of endovascularly
treated AIS patients.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Air Medical JournalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart disease and stroke statistics-2016 update: a report from the American Heart Association.Circulation. 2016; 133: e38-e360
- A population-based incidence of acute large vessel occlusions and thrombectomy eligible patients indicates significant potential for growth of endovascular stroke therapy in the USA.J Neurointerv Surg. 2017; 9: 722-726
- Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2019; 50: e344-e418
- Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials.Lancet. 2014; 384: 1929-1935
- Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis.JAMA. 2016; 316: 1279-1288
- Treatment with tissue plasminogen activator in the golden hour and the shape of the 4.5-hour time-benefit curve in the National United States Get With The Guidelines-stroke population.Circulation. 2017; 135: 128-139
- Deconstruction of interhospital transfer workflow in large vessel occlusion: real-world data in the thrombectomy era.Stroke. 2017; 48: 1976-1979
- Two paradigms for endovascular thrombectomy after intravenous thrombolysis for acute ischemic stroke.JAMA Neurol. 2017; 74: 549-556
- Drip, ship, and on-demand endovascular therapy for acute ischemic stroke.PLoS One. 2016; 11e150668
- Safety and time course of drip-and-ship in treatment of acute ischemic stroke.J Stroke Cerebrovasc Dis. 2017; 26: 2477-2481
- Characteristics of the drip-and-ship paradigm for patients with acute ischemic stroke in South Korea.J Stroke Cerebrovasc Dis. 2016; 25: 2678-2687
- Bypassing primary stroke centre reduces delay and improves outcomes for patients with large vessel occlusion.Eur Stroke J. 2016; 1: 85-92
- Interhospital transfer prior to thrombectomy is associated with delayed treatment and worse outcome in the STRATIS Registry.Circulation. 2017; 136: 2311-2321
- Mothership versus drip and ship for thrombectomy in patients who had an acute stroke: a systematic review and meta-analysis.J Neurointerv Surg. 2019; 11: 14-19
- Drip'n ship versus mothership for endovascular treatment: modeling the best transportation options for optimal outcomes.Stroke. 2017; 48: 791-794
- Drip and ship versus direct to comprehensive stroke center.Stroke. 2017; 48: 233-238
- Modeling stroke patient transport for all patients with suspected large-vessel occlusion.JAMA Neurol. 2018; 75: 1477-1486
- Prehospital triage of acute ischemic stroke patients to an intravenous tPA-ready versus endovascular-ready hospital: a decision analysis.Prehosp Emerg Care. 2018; 22: 722-733
- Decision analysis model for prehospital triage of patients with acute stroke.Stroke. 2019; 50: 970-977
- Thrombectomy accessibility after transfer from a primary stroke center: analysis of a three-year prospective registry.Int J Stroke. 2017; 12: 519-523
- Catalan Stroke Code and Reperfusion Consortium. Access to endovascular treatment in remote areas: analysis of the Reperfu-sion Treatment Registry of Catalonia.Stroke. 2016; 47: 1381-1384
- Stroke transfer and its organizational paradigm.Clin Neuroradiol. 2018; 28: 473-480
- Discharge destination as a surrogate for Modified Rankin Scale defined outcomes at 3- and 12-months poststroke among stroke survivors.Arch Phys Med Rehabil. 2012; 93: 1408-1413
- Modest association between the discharge modified Rankin Scale score and symptomatic intracerebral hemorrhage after intravenous thrombolysis.J Stroke Cerebrovasc Dis. 2015; 24: 548-553
- Abd Elalem Aziz M. Prediction of functional outcome in ischemic stroke patients: an observational study on Egyptian population.Cureus. 2017; 9: e1392
- Modern modelling techniques are data hungry: a simulation study for predicting dichotomous endpoints.BMC Med Res Methodol. 2014; 14: 137
- Minimum sample size for developing a multivariable prediction model: PART II - binary and time-to-event outcomes [erratum in Stat Med. 2019;38:5672].Stat Med. 2019; 38: 1276-1296
Article info
Publication history
Published online: January 16, 2021
Identification
Copyright
© 2021 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.
