J Neurocrit Care.  2018 Dec;11(2):86-92. 10.18700/jnc.180058.

Transportation Time is Significantly Decreased in Acute Ischemic Stroke Patients Under Drip-and-Ship Paradigm for Thrombolysis

• Kim JY
• Cha JK
• Kim DH
• Nah HW
• Jeong JH

• KMID: 2434834
• DOI: http://doi.org/10.18700/jnc.180058

Abstract

BACKGROUND
A delay of transfer for patients with acute stroke needing emergent revascularization is a huge hurdle for efficacy of revascularization. The objective of this study was to investigate changes of transportation time calculated by image to door (ITD) time (from checking brain images at first contact hospital to arriving at our emergency center) before and after 2015.
METHODS
This study was performed in a retrospective manner from 2013 into 2017. Acute ischemic stroke (AIS) patients having intravenous thrombolysis and/or mechanical thrombectomy during the observation period were enrolled. Among them, those who had revascularization under "˜Drip-and-Ship' or "˜Ship-and-Drip' paradigm were selected.
RESULTS
During the observation period, 225 patients were treated under "˜Drip-and-Ship' or "˜Ship-and-Drip' paradigm. Twenty-three were excluded due the lack of detailed data. Among 202 patients, 73 and 129 were treated under Drip-and-Ship and Ship-and-Drip paradigms, respectively. In 2013, 35 patients from 18 hospitals (median distance, 25 km) were transferred to our regional stroke center and their median ITD time was 116 minutes. It was gradually decreased after 2015. In 2017, ITD time was significantly (P < 0.01) shortened to 85 minutes without significant changes in transfer distance. The median onset to puncture time was also significantly (P=0.03) decreased from 365 minutes in 2013 to 270 minutes in 2017.
CONCLUSION
Our results implicate that many hospitals in our stroke region might have recognized the importance of rapid transportation for AIS after 2015.

Keyword

Stroke; Thrombectomy; Transportation

MeSH Terms

Brain
Emergencies
Humans
Punctures
Retrospective Studies
Stroke*
Thrombectomy
Transportation*

Figure

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  Figure 1. Box plots for door to image time (A) and onset to puncture time (B). The horizontal line inside each box indicates the median. Top and bottom of the box indicate interquartile range while I bars indicate 5th and 95th percentiles.

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  Figure 2. Location of Dong-A University Stroke Center and distribution of transfer hospitals. (A) In 2013, 18 neighboring hospitals that transferred patients to our center. (B) In 2014, 23 neighboring hospitals that transferred patients to our center. (C) In 2015, 19 neighboring hospitals that transferred patients to our center. (D) In 2016, 27 neighboring hospitals that transferred patients to our center. (E) In 2017, 24 neighboring hospitals that transferred patients to our center.

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