Outcomes in endovascular therapy for stroke similar across 3 triage concepts
Three triage options for patients receiving endovascular treatment for stroke conferred similarly good clinical outcomes, researchers reported.
Whether patients with stroke were admitted directly or secondarily transferred to a comprehensive stroke center or had a neurointerventionalist brought to them, all triage options were associated with good outcomes, according to the prospective, observational NEUROSQUAD study.
“As a principal finding, all three triage concepts achieved similar clinical outcome results. Although there seems to be a trend toward worse outcome in the ‘drive the doctor’ group, this might be due to slightly higher premorbid modified Rankin Scale scores. Thereby, NEUROSQUAD confirms the results of a recent retrospective study comparing clinical outcome in ‘drip and ship’ and ‘drive the doctor,’” Fatih Seker, MD, neuroradiologist at Heidelberg University Hospital, Germany, and colleagues wrote. “This adds more evidence that ‘drive the doctor’ is a valuable triage option in acute stroke care and can be considered, especially in underprivileged regions.”
The trial evaluated the effect of three triage pathways on outcomes in endovascular stroke treatment in Germany: direct admission to a comprehensive stroke center (mothership concept); secondary transfer to a comprehensive stroke center after diagnostic workup (drip and ship); and transfer of a neurointerventionalist to a remote hospital for thrombectomy (drive the doctor).
This trial included 360 patients with anterior circulation stroke and premorbid modified Rankin Scale (mRS) score of 0 to 3 who underwent thrombectomy within 24 hours of stroke onset. The primary outcome was good clinical outcome, defined as 90-day mRS score of 0 to 2 or clinical recovery to mRS before stroke onset. Secondary outcomes included successful reperfusion, NIH Stroke Scale score at discharge and mRS shift.
Overall, 30.8% of patients were directly admitted to a comprehensive stroke center, 56.7% were in the secondary transfer group and 12.5% were treated after transfer of a neurointerventionalist to a remote hospital.
According to the study, the primary outcome was achieved similarly in all three groups (mothership, 45.9% vs. drip and ship, 43.1% vs. drive the doctor ,40%; P = .778) and the frequency of successful reperfusion was similar (86.5% vs. 85.3% vs. 82.2%, respectively; P = .714).
Researchers observed no difference in any of the triage groups regarding the NIH Stroke Scale score at discharge (P = .115) and mRS shift (P = .342).
After a multivariate analysis, researchers determined that triage option was not an independent predictor of good clinical outcomes (unadjusted OR = 0.89; 95% CI, 0.64-1.23; P = .479).
“From a practical point of view, it needs to be noted that performing thrombectomy at another hospital can be technically challenging for neurointerventionalists because handling of the angiography unit may be unfamiliar,” the researchers wrote. “Also, the local staff (eg, technicians and anesthesiologists) may not be experienced with the thrombectomy procedure. Nonetheless, experience of the past years has shown that these obstacles can be overcome over time.”