Deans' stroke musings: Safety and Efficacy of the Telestroke Drip-and-Stay Model: A systematic review and meta-analysis

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, May 2, 2021

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

So being non-inferior it fails just as bad as these other methods.Good to know failure is being normalized. Only 12% get full recovery from tPA, which is complete failure in any sense of the word. Unless your tyranny of low expectations is so low that reperfusion alone is considered a success.

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

Hena Waseem¹, Yasir Salih², Charles Burney¹, Mark Abel¹, Natalie Riblet², Nathaniel Robbins³
¹Dartmouth Hitchcock Medical Center, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, ²The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, ³Dartmouth Hitchcock Medical Center

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”).

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.

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.