title: Poor Hypertension Control and Longer Transport Times Are Associated with Worse Outcome in Drip-and-Ship Stroke Patients.
abstract: BACKGROUND
  The "drip-and-ship" paradigm is an important treatment modality for acute ischemic stroke (AIS) patients who do not have immediate access to a comprehensive stroke center (CSC). Intravenous thrombolysis is initiated at a primary stroke center followed by expeditious transfer to a CSC. We sought to determine factors associated with poor outcomes in drip-and-ship AIS patients transferred to a CSC.
  
  
  METHODS
  This study is a retrospective analysis of 130 consecutive drip-and-ship patients transferred by ambulance to a single CSC between July 2012 and June 2014. Multiple patient and transport factors were analyzed. Transport blood pressure (BP) control was considered inadequate if the systolic BP was greater than 180 mmHg and/or diastolic BP was greater than 105 mmHg upon CSC arrival. Poor patient outcome was defined as discharge to hospice or expiry, a discharge modified Rankin Scale (mRS) score higher than 2, or symptomatic intracerebral hemorrhage (ICH).
  
  
  RESULTS
  There was a significant association between inadequate BP control upon CSC arrival and in-hospital mortality or discharge to hospice (P < .0007). Arrival BP was not associated with the risk of post-thrombolysis symptomatic ICH. Longer transport time was significantly associated with a poorer mRS score at discharge (P < .0174) and death (P < .0351).
  
  
  CONCLUSIONS
  Post-thrombolysis BP guideline violations and longer transport times during drip-and-ship transfers were significantly associated with poor outcome. Guidelines for strict transport BP management and alternative modes of transfer for longer-distance transports may be warranted.
authors.affiliation: Department of Neurology, North Shore University Hospital, Manhasset, New York.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Kodankandath
authors.affiliation: Department of Neurology, North Shore University Hospital, Manhasset, New York.
authors.forename: Jane
authors.initials: J
authors.lastname: Shaji
authors.affiliation: Department of Neurology, North Shore University Hospital, Manhasset, New York.
authors.forename: Nina
authors.initials: N
authors.lastname: Kohn
authors.affiliation: Department of Neurology, North Shore University Hospital, Manhasset, New York.
authors.forename: Rohan
authors.initials: R
authors.lastname: Arora
authors.affiliation: Department of Neurology, North Shore University Hospital, Manhasset, New York.
authors.forename: Elliott
authors.initials: E
authors.lastname: Salamon
authors.affiliation: Department of Neurology, North Shore University Hospital, Manhasset, New York.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Libman
authors.affiliation: Department of Neurology, North Shore University Hospital, Manhasset, New York. Electronic address: jkatz2@northwell.edu.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ischemic stroke; acute therapy; drip and ship; endovascular therapy; thrombolysis