title: Remote supervision of IV-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe.
abstract: OBJECTIVE
  Because of a shortage of stroke specialists, many outlying or "spoke" hospitals initiate intravenous (IV) thrombolysis using telemedicine or telephone consultation before transferring patients to a regional stroke center (RSC) hub. We analyzed complications and outcomes of patients treated with IV tissue plasminogen activator (tPA) using the "drip and ship" approach compared to those treated directly at the RSC.
  
  
  METHODS
  A retrospective review of our Get With the Guidelines Stroke (GWTG-Stroke) database from 01/2003 to 03/2008 identified 296 patients who received IV tPA within 3 hours of symptom onset without catheter-based reperfusion. GWTG-Stroke definitions for symptomatic intracranial (sICH), systemic hemorrhage, discharge functional status, and destination were applied. Follow-up modified Rankin Score was recorded when available.
  
  
  RESULTS
  Of 296 patients, 181 (61.1%) had tPA infusion started at an outside spoke hospital (OSH) and 115 (38.9%) at the RSC hub. OSH patients were younger with fewer severe strokes than RSC patients. Patients treated based on telestroke were more frequently octogenarians than patients treated based on a telephone consult. Mortality, sICH, and functional outcomes were not different between OSH versus RSC and telephone versus telestroke patients. Among survivors, mean length of stay was shorter for OSH patients but discharge status was similar and 75% of patients walked independently at discharge.
  
  
  CONCLUSIONS
  Outcomes in OSH "drip and ship" patients treated in a hub-and-spoke network were comparable to those treated directly at an RSC. These data suggest that "drip and ship" is a safe and effective method to shorten time to treatment with IV tPA.
authors.affiliation: Department of Neurology, Massachusetts General Hospital WACC 720, 55 Fruit Street, Boston MA 02114, USA.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Pervez
authors.forename: Gisele
authors.initials: G
authors.lastname: Silva
authors.forename: Shihab
authors.initials: S
authors.lastname: Masrur
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Betensky
authors.forename: Karen L
authors.initials: KL
authors.lastname: Furie
authors.forename: Renzo
authors.initials: R
authors.lastname: Hidalgo
authors.forename: Fabricio
authors.initials: F
authors.lastname: Lima
authors.forename: Eric S
authors.initials: ES
authors.lastname: Rosenthal
authors.forename: Natalia
authors.initials: N
authors.lastname: Rost
authors.forename: Anand
authors.initials: A
authors.lastname: Viswanathan
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000379:methods*; D011446:Prospective Studies; D019114:Remote Consultation / Q000379:methods; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D010959:Tissue Plasminogen Activator