Influences of different referral modes on clinical outcomes after endovascular therapy for acute ischemic stroke

Abstract

Background and purpose As endovascular thrombectomy (EVT) is time-dependent, it is crucial to refer patients promptly. Current referral modes include Mothership (MS), Drip and Ship (DS) and Drive the Doctor (DD). The purpose of this study was to investigate the influences of different referral modes on the clinical outcomes of patients with acute ischemic stroke after EVT. Methods A total of 349 patients from 15 hospitals between April 2017 and March 2020 were enrolled. The primary outcomes include poor outcome (modified Rankin Scale score of 3 to 6), symptomatic intracranial hemorrhage transformation (sICH), mortality and cost. Regression analysis was used to assess the association of referral modes with poor outcome, sICH, mortality and cost in acute ischemic stroke patients. Results Among the 349 patients, 83 were in DD group (23.78%), 85 in MS group (24.36%) and 181 in DS group (51.86%). There were statistically significant differences in intravenous thrombolysis, onset-to-door time, onset-to-puncture time, puncture-to-recanalization time, door-to-puncture time, door-to-recanalization time, and cost among the DD, MS, and DS groups (59.04% vs 35.29% vs 33.15%, P<0.001; 90 vs 166 vs 170 minutes, P<0.001; 230 vs 270 vs 270 minutes, P<0.001; 82 vs 54 vs 51 minutes, P<0.001; 110 vs 85 vs 96 minutes, P=0.004; 210 vs 146 vs 150 minutes, P<0.001; 64258 vs 80041 vs 70750 Chinese Yuan, P=0.018). In terms of sICH, mortality and poor outcome, there was no significant difference among the DD, MS, and DS groups (22.89% vs 18.82% vs 19.34%, P=0.758; 24.10% vs 24.71% vs 29.83%, P=0.521; 64.47% vs 64.71% vs 68.51%, P=0.827). The results of multiple regression analysis indicated that there was no independent correlation between different referral modes regarding sICH (ORMS: 0.50, 95%CI: 0.18, 1.38, P=0.1830; ORDS: 0.47, 95%CI: 0.19, 1.16, P=0.1000), mortality (ORMS: 0.56, 95%CI: 0.19, 1.67, P=0.2993; ORDS: 0.65, 95%CI: 0.25, 1.69, P=0.3744) and poor outcome (ORMS: 0.61, 95%CI: 0.25, 1.47, P=0.2705; ORDS: 0.53, 95%CI: 0.24, 1.18, P=0.1223). However, there was a correlation between MS group and cost (β=30449.73, 95%CI: 11022.18, 49877.29; P=0.0023). The multiple regression analysis on patients finally admitted in comprehensive stroke center (MS+DS) versus patients finally admitted in primary stroke center (DD) showed that DD mode was independently associated with lower costs (β=-19438.86, 95%CI: -35977.79, -2899.94; P=0.0219). Conclusion There was no independent correlation between three referral modes and sICH, mortality, poor outcome correspondingly. Different referral modes can be implemented in clinical practice according to the situations encountered. Compared to MS and DS modes, DD mode is more economical.

Impact of Direct Transport to Thrombectomy-Capable Center vs. Nearby/Distant Local Stroke Centers on Stroke Outcome in Patients Undergoing Thrombectomy: A Real-Life Study

“…In some of these observational studies, the secondary transfer model showed a lower percentage of patients receiving IVT [14], while others observed higher rates of IVT in this model [16]. In our cohort, we did not find significant differences in this regard.…”

“…However, the relative benefit from the MT did not differ significantly in the two groups [13]. Other real-life studies with a design similar to ours have not reported significant differences in the functional outcome, substantial recanalization, or symptomatic hemorrhagic transformation between the two transfer models, although the process times were longer in the secondary transfer groups in most cases [14][15][16][17][18][19][20][21].…”

“…None of these studies stratified the data according to the distance from the primary center or the transfer time to the TC in order to assess the specific impact of distance on the transfer models. In some cases, the primary centers were located within less than 17 km [14], while in others, the distance was significantly greater and heterogeneous between centers or not reported [15,16,22]. In a study by Rinaldo et al, the mortality was significantly lower among directly admitted patients than among transferred patients, and an increased distance between the transferring hospital and the TC was associated with an increased risk of mortality [23].…”

Clinical outcomes after endovascular thrombectomy in different triage methods

“…The data of our study was collected from Beijing Chaoyang hospital of Capital Medical University and medical consortium. The statistical results showed that the OGT of our study was longer than other studies [ [9] , [10] , [11] , [12] ]. Our center has established an integrated health care system with PSC, and medical conditions in capital of China is developed relatively.…”

Post-ASPECTS and Post-PC-ASPECTS Predict the Outcome of Anterior and Posterior Ischemic Stroke Following Thrombectomy

“…[36][37][38] Time is brain; we should spare no effort to help reduce procedural times and LKNPT through workflow optimization with multidisciplinary collaboration, reduce infarct volume and early prediction to improve endovascular time metrics and patient outcomes. [39][40][41][42][43] DRT and PRT can be further shortened through the standardization of acute stroke workflows to improve patient outcomes. 40 The main limitations of this study include its retrospective study design and small sample size.…”