Mothership versus Drip-and-Ship for stroke in a rural area: A French prospective observational study.

IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Revue neurologique Pub Date : 2024-07-29 DOI:10.1016/j.neurol.2024.06.007
M Raquin, C Lambert, P Paris, N Bourgois, P Clavelou, X Moisset, A Ferrier
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Abstract

Background: The availability of mechanical thrombectomy (MT) is limited. Thus, there are two paradigms for patients living closer to a primary stroke center (PSC) than a comprehensive stroke center (CSC) capable of MT: "Mothership" (direct referral to a CSC) and "Drip-and-Ship" (referral to a PSC for imaging and thrombolysis and transfer to a CSC for thrombectomy or monitoring). We aimed to compare the prognosis of patients at three months between the two paradigms in a rural area.

Materials: From September 2019 to March 2021, we prospectively included patients living closer to a PSC than the one CSC, regardless of the type of stroke or reperfusion treatment. The proportion of patients with a good functional outcome (Rankin≤2) at three months was compared between the two initial orientations for all patients and for subgroups: patients with ischemic stroke and patients treated by MT.

Results: Among the 206 patients included, 103 were admitted directly to the CSC (82.5% had an ischemic stroke and 24.3% a MT) and 103 initially admitted to a PSC and then transferred to the CSC (100% had an ischemic stroke and 52.4% a MT). The proportion of patients with a good outcome was comparable between the two groups (54.5% vs. 43.7%, P=0.22). Among the 79 patients who underwent MT, the prognosis at three months was better in the Mothership group (49.3% vs. 15.3%, P=0.01).

Conclusion: The functional prognosis is comparable between Mothership and Drip-and-Ship paradigms in our setting, despite a trend towards a better prognosis for the Mothership. As has been shown in urban settings, the mothership paradigm also leads to a better prognosis for patients treated with MT in a rural setting.

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在农村地区治疗中风的母婴护理与滴注护理:一项法国前瞻性观察研究。
背景:机械取栓术(MT)的可用性有限。因此,对于居住地距离初级卒中中心(PSC)比综合卒中中心(CSC)更近且有能力进行机械取栓术的患者,有两种治疗模式:"母船"(直接转诊至综合卒中中心)和 "滴灌-转运"(转诊至初级卒中中心进行影像学检查和溶栓,然后转运至综合卒中中心进行血栓切除术或监测)。我们的目的是在农村地区比较两种模式下患者三个月后的预后:从 2019 年 9 月到 2021 年 3 月,我们前瞻性地纳入了居住在离 PSC 比 CSC 更近的患者,无论中风或再灌注治疗的类型如何。结果:在纳入的206名患者中,有103人的功能预后良好(Rankin≤2):在纳入的 206 例患者中,103 例直接入住 CSC(82.5% 为缺血性卒中,24.3% 为 MT),103 例最初入住 PSC 后转入 CSC(100% 为缺血性卒中,52.4% 为 MT)。两组患者预后良好的比例相当(54.5% 对 43.7%,P=0.22)。在接受MT的79名患者中,母船组患者三个月后的预后更好(49.3%对15.3%,P=0.01):结论:在我们的环境中,母船式和点滴加船式的功能性预后相当,尽管母船式的预后有更好的趋势。正如在城市环境中所显示的那样,在农村环境中,母船模式也能为接受 MT 治疗的患者带来更好的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Revue neurologique
Revue neurologique 医学-临床神经学
CiteScore
4.80
自引率
0.00%
发文量
598
审稿时长
55 days
期刊介绍: The first issue of the Revue Neurologique, featuring an original article by Jean-Martin Charcot, was published on February 28th, 1893. Six years later, the French Society of Neurology (SFN) adopted this journal as its official publication in the year of its foundation, 1899. The Revue Neurologique was published throughout the 20th century without interruption and is indexed in all international databases (including Current Contents, Pubmed, Scopus). Ten annual issues provide original peer-reviewed clinical and research articles, and review articles giving up-to-date insights in all areas of neurology. The Revue Neurologique also publishes guidelines and recommendations. The Revue Neurologique publishes original articles, brief reports, general reviews, editorials, and letters to the editor as well as correspondence concerning articles previously published in the journal in the correspondence column.
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