Abstract Details

Title Safety and Efficacy of the Telestroke Drip-and-Stay Model: A systematic review and meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S30 - Cerebrovascular Disease and Interventional Neurology 3 (4:00 PM-4:08 PM)

Poster/Presentation
Number 001

Background In the “drip-and-stay” model of telestroke care patients presenting at a spoke facility complete their entire hospital stay at the spoke. Despite potential benefits, including resource utilization, the drip-and-stay model has not yet been widely adopted, and relatively little is known about outcomes compared to hub or drip-and-ship models.

Objective To compare outcomes between two models of acute ischemic stroke care in patients treated with IV tissue plasminogen activator (tPA) at a spoke hospital in a telestroke network, with subsequent treatment at the spoke hospital (“drip-and-stay”), compared with treatment with tPA at a spoke hospital with subsequent transfer to a hub hospital (“drip-and-ship”), or both tPA and subsequent treatment at a hub hospital (“hub”).

Design/Methods We performed a systematic review and meta-analysis according to PRISMA guidelines. Literature searches of MEDLINE, Embase, and Cochrane from inception-October 2019 included randomized control trials (RCTs) and observational cohort studies comparing the drip-and-stay model to hub and drip-and-ship models. Outcomes of interest were functional independence (modified Rankin scale), symptomatic intracranial hemorrhage (sICH), mortality, and length of stay (LOS). Pooled effect estimates were calculated using a fixed-effects meta-analysis and random-effects Bayesian meta-analysis. Non-inferiority was calculated using a fixed-margin method.

Results Of 2,806 unique records identified, 10 studies, totaling 4,164 patients, fulfilled the eligibility criteria. Meta-analysis found no significant difference in functional outcomes (mRS 0-1) (6 studies, RR=1.09, 95%CI 0.98-1.22, p=0.123), sICH (8 studies, RR=0.98, 95%CI 0.64-1.51, p=0.942), or 90-day mortality (5 studies, RR=0.98, 95%CI 0.73-1.32, p=0.911, respectively) between patients treated in a drip-and-stay model compared to patients treated in drip-and-ship or hub models. No outcomes showed significant heterogeneity. Drip-and-stay outcomes (mRS 0-1, sICH) were non-inferior when compared to the combined group.

Conclusions Our findings indicate that drip-and-stay is non-inferior to current models of hub and drip-and-ship stroke care, and may be as safe and as effective as either.

Authors/Disclosures
Yasir Salih, DO (Mount Sinai Beth Israel) PRESENTER	Dr. Salih has nothing to disclose.
Hena Waseem, MD (Stanford University Hospital)	Dr. Waseem has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Nathaniel M. Robbins, MD (MGB)	Dr. Robbins has received personal compensation in the range of $0-$499 for serving as a Consultant for Red Nucleus. Dr. Robbins has received personal compensation in the range of $0-$499 for serving as a Consultant for TDG Health. Dr. Robbins has received personal compensation in the range of $0-$499 for serving as a Consultant for Jupiter Life Science Consulting. Dr. Robbins has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Vickery & Shepherd. Dr. Robbins has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Vaccine Injury Compensation Program. The institution of Dr. Robbins has received research support from Diamond Endowment Fund. The institution of Dr. Robbins has received research support from Reeves Endowment Fund. The institution of Dr. Robbins has received research support from Institute for Ethnomedicine. The institution of Dr. Robbins has received research support from Vertex Pharmaceuticals . Dr. Robbins has received personal compensation in the range of $50,000-$99,999 for serving as a Neurohospitalist with Hayes Locums.