In a study published in Stroke, there were no significant differences in the number of patients achieving a good outcome (90-day modified Rankin score [mRS] < 2) when comparing patients treated for ischemic stroke using a “drip-and-ship” model vs those treated with a “drip-and-stay model. Overall, there were no differences between the groups in length of stay, in-hospital mortality, or status at discharge.
All 430 patients in the study initially presented and were treated with tissue-type plasminogen activator (tPA) at 1 of 17 spoke hospitals in the same healthcare system. Of those individuals, 232 were transferred to the system’s central hub hospital (drip-and-ship model); the other 198 patients were admitted to the spoke hospital and stroke care was provided via telemedicine (drip-and-stay model).
Upon arrival at the spoke hospital, the median National Institutes of Health Stroke Scale (NIHSS) score for those who were transferred (drip-and-ship) was 10 (interquartile range 5-18) vs 6 (interquartile range 4-10; P < .001) for those admitted to the spoke hospital (drip-and-stay).
Patients in the study were treated between September 2015 and December 2016 and identified retrospectively. Demographic, clinical, and outcome data were obtained prospectively using a telemedicine registry. The 90-day mRS score was available for 64% of the patients.
Harold P. Adams, Jr, MD, Professor of Neurology at the University of Iowa and Founding Editorial Board member for Practical Neurologysaid, “This is an interesting observation and is important in an era with an emphasis on transferring patients with large artery occlusion who need endovascular therapy. Still, the spoke hospitals in this study did have telemedicine follow up available from the central-hub hospital, a situation that may not be available in many institutions. Thus, the model of drip and ship remains important for many communities, particularly in rural areas.”
Zehra Farzal, MD; Guillaume Lamotte MD, MSc; and Laxman B. Bahroo, DO
Brian J. Williams, MD