Evidence map›Paper›PMID 37507617›Full record

ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2024

Comparison between different referral strategies for acute ischemic stroke patients in a hub-spoke emergency stroke network: a real-world experience in south-east Lazio.

F Sallustio, A P Mascolo, F Marrama, G Lacidogna, F D'Agostino, A Rocco, R Gandini, D Morosetti, V Da Ros, M Nezzo and 4 more

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Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

F SallustioComprehensive Stroke Center, Department of Systems Medicine, University of Tor Vergata, Rome, Italy. fsall75@gmail.com.ORCID http://orcid.org/0000-0002-8229-465X
A P MascoloComprehensive Stroke Center, Department of Systems Medicine, University of Tor Vergata, Rome, Italy.
F MarramaComprehensive Stroke Center, Department of Systems Medicine, University of Tor Vergata, Rome, Italy.
G LacidognaComprehensive Stroke Center, Department of Systems Medicine, University of Tor Vergata, Rome, Italy.
F D'AgostinoComprehensive Stroke Center, Department of Systems Medicine, University of Tor Vergata, Rome, Italy.
A RoccoComprehensive Stroke Center, Department of Systems Medicine, University of Tor Vergata, Rome, Italy.
R GandiniInterventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.
D MorosettiInterventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.
V Da RosInterventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.
M NezzoInterventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.
R ArgiròInterventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.
M PloccoNeurovascular Therapy Unit, F. Spaziani Hospital, Rome, Frosinone, Italy.
F AlemsegedDepartment of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.
M DiomediComprehensive Stroke Center, Department of Systems Medicine, University of Tor Vergata, Rome, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimTo describe different referral strategies for acute ischemic stroke (AIS) patients in a Hub-Spoke emergency stroke network with their incidence, time metrics and related outcomes.

methodsReferral paradigms were defined as follows: primary transfer to the comprehensive stroke center (CSC) from a remote region, called mothership (MS); secondary transfer to the CSC from a primary stroke center where intravenous thrombolysis was available, called drip and ship (DS); secondary transfer to the CSC from a community hospital where no reperfusion therapy was available, called ship and drip (SD); primary transfer to the CSC from its catchment area, called direct CSC (dCSC).

resultsAmong 517 anterior circulation AIS patients treated with mechanical thrombectomy between 2015 and 2020, 16.6% of them were SD, in addition to the well-known referral paradigms of MS (21.8%) and DS (18.1%). This rate grew to 30% when only patients whose place of onset was outside the CSC catchment area were considered. In the SD group, onset to CSC and onset to groin were significantly longer (178±80 min vs. 102±60 min, p<0.001, and 277±77 min vs. 211±61 min, p<0.001, respectively), and the risk of any intracranial hemorrhage (ICH) was significantly higher (OR: 2.514; 95%CI: 1.18-5.35, p=0.017) compared to MS.

conclusionIn this hub-spoke stroke network, a high proportion of SD paradigm was found, which was associated with longer times to treatment and higher rates of any ICH. A closer cooperation between hospital stroke physicians, national health system staff, and paramedics is warranted to identify the most appropriate referral strategy for each patient.

Indexed as

Brain IschemiaIschemic StrokeStrokeHumansIntracranial HemorrhagesPatient TransferReferral and ConsultationRetrospective StudiesThrombectomyThrombolytic TherapyTreatment OutcomeAcute ischemic strokeReperfusion strategiesStroke network

Identifiers

PMID37507617

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.