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 Robbins^3
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.