TY - JOUR
T1 - Outcomes Among Patients With Ischemic Stroke Treated With Intravenous tPA (Tissue-Type Plasminogen Activator) via Telemedicine
T2 - Is the Drip-and-Stay Model Safe?
AU - Wysocki, Nicole Anne
AU - Bambhroliya, Arvind
AU - Ankrom, Christy
AU - Vahidy, Farhaan
AU - Astudillo, César
AU - Trevino, Alyssa
AU - Malazarte, Rene
AU - Cossey, T. C.
AU - Jagolino-Cole, Amanda
AU - Savitz, Sean
AU - Wu, Tzu Ching
AU - Sharrief, Anjail
N1 - Funding Information:
This study was supported by the National Institutes of Health, McGovern Medical School Stroke Training Program T32; 5T32NS007412-19. This research is also made possible by funding from the State of Texas Legislature to the Lone Star Stroke Clinical Research Consortium. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the State of Texas.
Publisher Copyright:
© 2019 American Heart Association, Inc.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Background and Purpose - Telemedicine is increasingly utilized for intravenous tPA (tissue-type plasminogen activator) delivery. The comparative safety of leaving tPA-treated patients at a presenting (spoke) hospital (drip-and-stay) or transferring patients to a central treating (hub) hospital (drip-and-ship) is not established. We sought to compare outcomes between drip-and-ship and drip-and-stay patients treated with tPA via telemedicine. We hypothesized that there would be no differences in short-term outcomes of in-hospital mortality, length of stay, or discharge disposition or in 90-day outcomes between groups. Methods - We retrospectively identified patients treated with tPA at 17 spoke hospitals between September 2015 and December 2016. Demographic, clinical, and outcome data were obtained from a prospective telemedicine registry. We used negative binomial, multinomial, and logistic regression analyses to evaluate length of stay, discharge disposition, and inpatient mortality, respectively. We compared the proportion of patients with 90-day modified Rankin Scale score <2 by group. Results - Among 430 tPA-treated patients, 232 (53.9%) were transferred to the hub after treatment. The median arrival National Institutes of Health Stroke Scale score was higher for drip-and-ship (10; interquartile range, 5-18) compared with drip-and-stay patients (6; interquartile range, 4-10; P<0.001). Unadjusted length of stay was longer in drip-and-stay patients (incidence rate ratio, 0.82; 95% CI, 0.71-0.95). There were no significant differences in adjusted length of stay, hospital mortality, or discharge disposition. Among the 64% of patients with complete 90-day modified Rankin Scale score, the proportion with good outcomes (modified Rankin Scale score <2) did not differ between groups. Conclusions - We found no differences in measured outcomes between drip-and-ship and drip-and-stay patients treated in our network, although our study may be underpowered to detect small differences.
AB - Background and Purpose - Telemedicine is increasingly utilized for intravenous tPA (tissue-type plasminogen activator) delivery. The comparative safety of leaving tPA-treated patients at a presenting (spoke) hospital (drip-and-stay) or transferring patients to a central treating (hub) hospital (drip-and-ship) is not established. We sought to compare outcomes between drip-and-ship and drip-and-stay patients treated with tPA via telemedicine. We hypothesized that there would be no differences in short-term outcomes of in-hospital mortality, length of stay, or discharge disposition or in 90-day outcomes between groups. Methods - We retrospectively identified patients treated with tPA at 17 spoke hospitals between September 2015 and December 2016. Demographic, clinical, and outcome data were obtained from a prospective telemedicine registry. We used negative binomial, multinomial, and logistic regression analyses to evaluate length of stay, discharge disposition, and inpatient mortality, respectively. We compared the proportion of patients with 90-day modified Rankin Scale score <2 by group. Results - Among 430 tPA-treated patients, 232 (53.9%) were transferred to the hub after treatment. The median arrival National Institutes of Health Stroke Scale score was higher for drip-and-ship (10; interquartile range, 5-18) compared with drip-and-stay patients (6; interquartile range, 4-10; P<0.001). Unadjusted length of stay was longer in drip-and-stay patients (incidence rate ratio, 0.82; 95% CI, 0.71-0.95). There were no significant differences in adjusted length of stay, hospital mortality, or discharge disposition. Among the 64% of patients with complete 90-day modified Rankin Scale score, the proportion with good outcomes (modified Rankin Scale score <2) did not differ between groups. Conclusions - We found no differences in measured outcomes between drip-and-ship and drip-and-stay patients treated in our network, although our study may be underpowered to detect small differences.
KW - hospitals
KW - humans
KW - inpatients
KW - registries
KW - telemedicine
UR - http://www.scopus.com/inward/record.url?scp=85063711764&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85063711764&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.118.024703
DO - 10.1161/STROKEAHA.118.024703
M3 - Article
C2 - 30852962
AN - SCOPUS:85063711764
SN - 0039-2499
VL - 50
SP - 895
EP - 900
JO - Stroke
JF - Stroke
IS - 4
ER -