Department of Neurology, Massachusetts General Hospital WACC 720, 55 Fruit Street, Boston MA 02114, USA.
Stroke. 2010 Jan;41(1):e18-24. doi: 10.1161/STROKEAHA.109.560169. Epub 2009 Nov 12.
Because of a shortage of stroke specialists, many outlying or "spoke" hospitals initiate intravenous (IV) thrombolysis using telemedicine or telephone consultation before transferring patients to a regional stroke center (RSC) hub. We analyzed complications and outcomes of patients treated with IV tissue plasminogen activator (tPA) using the "drip and ship" approach compared to those treated directly at the RSC.
A retrospective review of our Get With the Guidelines Stroke (GWTG-Stroke) database from 01/2003 to 03/2008 identified 296 patients who received IV tPA within 3 hours of symptom onset without catheter-based reperfusion. GWTG-Stroke definitions for symptomatic intracranial (sICH), systemic hemorrhage, discharge functional status, and destination were applied. Follow-up modified Rankin Score was recorded when available.
Of 296 patients, 181 (61.1%) had tPA infusion started at an outside spoke hospital (OSH) and 115 (38.9%) at the RSC hub. OSH patients were younger with fewer severe strokes than RSC patients. Patients treated based on telestroke were more frequently octogenarians than patients treated based on a telephone consult. Mortality, sICH, and functional outcomes were not different between OSH versus RSC and telephone versus telestroke patients. Among survivors, mean length of stay was shorter for OSH patients but discharge status was similar and 75% of patients walked independently at discharge.
Outcomes in OSH "drip and ship" patients treated in a hub-and-spoke network were comparable to those treated directly at an RSC. These data suggest that "drip and ship" is a safe and effective method to shorten time to treatment with IV tPA.
由于脑卒中专家短缺，许多偏远或“分支”医院在将患者转至区域脑卒中中心（RSC）枢纽之前，通过远程医疗或电话咨询启动静脉（IV）溶栓治疗。我们分析了使用“滴注和转运”方法治疗接受 IV 组织型纤溶酶原激活剂（tPA）的患者的并发症和结局，并与直接在 RSC 接受治疗的患者进行了比较。
我们对 2003 年 1 月至 2008 年 3 月期间的 Get With the Guidelines Stroke（GWTG-Stroke）数据库进行了回顾性分析，确定了 296 例在症状发作后 3 小时内接受 IV tPA 治疗且未进行导管溶栓的患者。应用 GWTG-Stroke 对症状性颅内出血（sICH）、全身性出血、出院功能状态和出院去向进行定义。在有随访改良 Rankin 评分记录时进行记录。
在 296 例患者中，有 181 例（61.1%）在外部分支医院（OSH）开始接受 tPA 输注，115 例（38.9%）在 RSC 枢纽开始接受治疗。OSH 患者比 RSC 患者更年轻，且脑卒中严重程度较低。基于远程脑卒中治疗的患者比基于电话咨询治疗的患者更常为 80 岁以上的老年人。OSH 与 RSC 患者以及电话与远程脑卒中患者之间的死亡率、sICH 和功能结局无差异。在幸存者中，OSH 患者的平均住院时间较短，但出院状态相似，75%的患者出院时能独立行走。
在“分支和枢纽”网络中接受 OSH“滴注和转运”治疗的患者的结局与直接在 RSC 接受治疗的患者相似。这些数据表明，“滴注和转运”是缩短 IV tPA 治疗时间的安全有效的方法。
