Abstract
BackgroundChulalongkorn Stroke Center is a comprehensive stroke center (CSC) located in Bangkok, Thailand. Our stroke network consists of different levels of spoke hospitals, ranging from community hospitals where thrombolytic treatment is not available, to those capable of onsite thrombolytic therapy. This study aimed to assess the time to treatment and outcomes among acute ischemic stroke patients who received thrombolytic treatment in the Chulalongkorn Stroke Network by 1.) Direct arrival at the CSC (mothership) 2.) Telestroke-assisted thrombolytic treatment with secondary transfer to the CSC (drip-and-ship) 3.) Referral from community hospital to the CSC for thrombolytic treatment (ship-and-drip).MethodsAcute ischemic stroke patients who received thrombolytic treatment during January 2016–December 2017 in the Chulalongkorn Stroke Network were studied. Time to treatment and clinical outcomes were compared among treatment groups.ResultsThere were 273 patients in the study including 147, 87, and 39 patients in mothership, drip-and-ship, and ship-and-drip paradigms, respectively. The door-to-needle-time (DTN) and onset-to-needle-time (OTN) times were significantly longest in ship-and-drip group (146.5 ± 62/205.03 ± 44.88 mins) compared to mothership (38 ± 23/155.2 ± 60.54 mins) and drip-and-ship (63.0 ± 44/166.09 ± 87 mins), P < 0.05. There was no significant difference regarding functional independence defined by modified Rankin Scale (mRS) ≤ 2 at 3 months (P = 0.12), in-hospital mortality (P = 0.37), mortality at 3 months (P = 0.73), and symptomatic intracerebral hemorrhage (P = 0.24) among groups.ConclusionThrombolytic treatment with drip and ship method under teleconsultation is feasible in Thailand. There was no difference of clinical outcome among the 3 treatment paradigms. However, DTN time and OTN time were longest in the ship-and-drip paradigm.
Highlights
Chulalongkorn Stroke Center is a comprehensive stroke center (CSC) located in Bangkok, Thailand
Patients were divided into 3 groups including 1.) Patients directly arriving at Chulalongkorn Comprehensive Stroke Center (CSC) (“mothership” protocol) 2.) Patients receiving intravenous thrombolytic therapy via telestroke consultation at the spoke hospital with secondary transfer to the CSC (“drip-and-ship” protocol) 3.) Patients who presented at the community hospital with secondary transfer to the CSC for thrombolytic treatment (“ship-and-drip” protocol)
Data consisting of National Institute of Health Stroke Scale (NIHSS), functional outcome assessed by modified Rankin Scale, and mortality were reviewed in the medical records from the stroke clinic
Summary
Chulalongkorn Stroke Center is a comprehensive stroke center (CSC) located in Bangkok, Thailand. Intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) is the standard treatment of acute ischemic stroke [2]. In Thailand, the first thrombolytic treatment for acute ischemic stroke was given at King Chulalongkorn Memorial Hospital in 1996 [4]. The Ministry of Public Health and the National Health Security Office (NHSO) had accepted the use of intravenous thrombolysis as the standard treatment of acute ischemic stroke in 2008. The national thrombolytic treatment for acute ischemic stroke rate has been increased from 0.38% in 2008 [1] to 4.36% in 2015 [6]. The complexity of the stroke fast track system, which requires multidisciplinary team, management in a timely manner, and lack of stroke specialists limits the availability of thrombolytic treatment in Thailand mainly to provincial and university hospitals
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