Abstract WMP19: Are “Drip and Ship” Patients Different than Other rt-PA Treated Patients? Clinical Characteristics and Patient Outcomes.
Introduction: Many large stroke centers provide remote acute stroke consultation to partner hospitals via telephone or video, followed by transfer of the patient to the central hospital (“drip and ship” (DS)). We used data from a large, quality-oriented database to describe the characteristics and outcomes of drip and ship patients compared to patients that received rt-PA and were admitted at the same institution (“front door” (FD) cases).
Methods: We analyzed acute ischemic stroke cases treated with rt-PA in Get With The Guidelines-Stroke (GWTG-Stroke) between April 2003 and October, 2010. Data were included from fully participating GWTG-Stroke hospitals with discharge information available. Categorical data were analyzed by Pearson chi-square test and continuous data by Wilcoxon test.
Results: A total of 44,667 rt-PA treated ischemic stroke pts from 1440 hospitals were included in this analysis, of which 34,192 were front door cases, and 10,475 were drip and ship. DS cases were slightly younger (69yo vs. 72yo), and were more likely male (46% vs. 50%), white (81% vs. 75%), and had lower NIHSSS (11 vs. 12), p<0.001 for all comparisons. The DS patients were statistically less likely to report hypertension, atrial fibrillation, and prior stroke history, but absolute differences were small (see Table). In-hospital mortality was similar for DS vs. FD (10.9% vs. 9.6%), as was the symptomatic intracranial hemorrhage rate <36hrs (5.8% vs. 5.2%), and discharge to home (41% vs. 40%).
Discussion: Within the GWTG-Stroke database, 23% of rt-PA-treated ischemic stroke are “drip and ship” patients, and have similar demographics and co-morbidities to “front-door” treated patients. Clinical outcomes, including in-hospital mortality and symptomatic hemorrhage are also similar. These data demonstrate that the current national paradigm of remote consultation for acute ischemic stroke thrombolysis is as safe as in-person consultation.
- © 2012 by American Heart Association, Inc.