title: Patient Selection for Drip and Ship Thrombolysis in Acute Ischemic Stroke.
abstract: OBJECTIVE
  The drip and ship model is a method used to deliver thrombolysis to acute stroke patients in facilities lacking onsite neurology coverage. We sought to determine whether our drip and ship population differs from patients treated directly at our stroke center (direct presenters).
  
  
  METHODS
  We retrospectively reviewed consecutive patients who received thrombolysis at an outside facility with subsequent transfer to our center between 2009 and 2011. Patients received thrombolysis after telephone consultation with a stroke specialist. We examined demographics, vascular risk factors, laboratory values, and stroke severity in drip and ship patients compared with direct presenters.
  
  
  RESULTS
  Ninety-six patients were identified who received thrombolysis by drip and ship compared with 212 direct presenters. The two groups did not differ with respect to sex, ethnicity, vascular risk factors, or admission glucose. The odds ratio (OR) of arriving at our hospital as a drip and ship for someone 80 years or older was 0.31 (95% confidence interval [CI] 0.15-0.61, P < 0.001). Only 21% of drip and ship patients were black versus 38% of direct presenters (OR 0.434, 95% CI 0.25-0.76, P = 0.004). Even after stratifying by age (<80 vs ≥80), a smaller proportion of drip and ship patients were black (OR 0.44, 95% CI 0.24-0.81, P = 0.008). Furthermore, we found that fewer black patients with severe strokes arrived by drip and ship (OR 0.33, 95% CI 0.11-0.98, P = 0.0028).
  
  
  CONCLUSIONS
  Our study showed that a smaller proportion of blacks and older adults arrived at our center by the drip and ship model. This may reflect differences in how patients are selected for thrombolysis and transfer to a higher level of care.
authors.affiliation: From the Department of Neurology, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, the Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee, the Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia, the National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, Bethesda, Maryland, and the Department of Neurology, School of Medicine, University of Tennessee, Memphis.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lyerly
authors.affiliation: From the Department of Neurology, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, the Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee, the Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia, the National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, Bethesda, Maryland, and the Department of Neurology, School of Medicine, University of Tennessee, Memphis.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: From the Department of Neurology, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, the Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee, the Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia, the National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, Bethesda, Maryland, and the Department of Neurology, School of Medicine, University of Tennessee, Memphis.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: From the Department of Neurology, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, the Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee, the Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia, the National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, Bethesda, Maryland, and the Department of Neurology, School of Medicine, University of Tennessee, Memphis.
authors.forename: Reza Bavarsad
authors.initials: RB
authors.lastname: Shahripour
authors.affiliation: From the Department of Neurology, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, the Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee, the Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia, the National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, Bethesda, Maryland, and the Department of Neurology, School of Medicine, University of Tennessee, Memphis.
authors.forename: John P
authors.initials: JP
authors.lastname: Donnelly
authors.affiliation: From the Department of Neurology, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, the Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee, the Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia, the National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, Bethesda, Maryland, and the Department of Neurology, School of Medicine, University of Tennessee, Memphis.
authors.forename: James T
authors.initials: JT
authors.lastname: Houston
authors.affiliation: From the Department of Neurology, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, the Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee, the Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia, the National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, Bethesda, Maryland, and the Department of Neurology, School of Medicine, University of Tennessee, Memphis.
authors.forename: Pawan V
authors.initials: PV
authors.lastname: Rawal
authors.affiliation: From the Department of Neurology, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, the Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee, the Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia, the National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, Bethesda, Maryland, and the Department of Neurology, School of Medicine, University of Tennessee, Memphis.
authors.forename: Niren
authors.initials: N
authors.lastname: Kapoor
authors.affiliation: From the Department of Neurology, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, the Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee, the Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia, the National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, Bethesda, Maryland, and the Department of Neurology, School of Medicine, University of Tennessee, Memphis.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Alvi
authors.affiliation: From the Department of Neurology, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, the Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee, the Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia, the National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, Bethesda, Maryland, and the Department of Neurology, School of Medicine, University of Tennessee, Memphis.
authors.forename: April
authors.initials: A
authors.lastname: Sisson
authors.affiliation: From the Department of Neurology, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, the Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee, the Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia, the National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, Bethesda, Maryland, and the Department of Neurology, School of Medicine, University of Tennessee, Memphis.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Alexandrov
authors.affiliation: From the Department of Neurology, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, the Department of Neurology, School of Medicine, Vanderbilt University, Nashville, Tennessee, the Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia, the National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics and Therapeutics, Bethesda, Maryland, and the Department of Neurology, School of Medicine, University of Tennessee, Memphis.
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000379:methods*; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D010360:Patient Transfer / Q000379:methods / Q000458:organization & administration; D019114:Remote Consultation / Q000379:methods*; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014481:United States / Q000453:epidemiology; D001741:Black or African American
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator