Background and Purpose- Health systems are faced with the challenge of ensuring fast access to appropriate therapy for patients with acute stroke. The paradigms primarily discussed are mothership and drip and ship. Less attention has been focused on the drip-and-drive (DD) paradigm. Our aim was to analyze whether and under what conditions DD would predict the greatest probability of good outcome for patients with suspected ischemic stroke in Northwestern Germany. Methods- Conditional probability models based on the decay curves for endovascular therapy and intravenous thrombolysis were created to determine the best transport paradigm, and results were displayed using map visualizations. Our study area consisted of the federal states of Lower Saxony, Hamburg, and Schleswig-Holstein in Northwestern Germany covering an area of 64 065 km2 with a population of 12 703 561 in 2017 (198 persons per km2). In several scenarios, the catchment area, that is, the region that would result in the greatest probability of good outcomes, was calculated for each of the mothership, drip-and-ship, and the DD paradigms. Several different treatment time parameters were varied including onset-to-first-medical-response time, ambulance-on-scene time, door-to-needle time at primary stroke center, needle-to-door time, door-to-needle time at comprehensive stroke center, door-to-groin-puncture time, needle-to-interventionalist-leave time, and interventionalist-arrival-to-groin-puncture time. Results- The mothership paradigm had the largest catchment area; however, the DD catchment area was larger than the drip-and-ship catchment area so long as the needle-to-interventionalist-leave time and the interventionalist-arrival-to-groin-puncture time remain <40 minutes each. A slowed workflow in the DD paradigm resulted in a decrease of the DD catchment area to 1221 km2 (2%). Conclusions- Our study suggests the largest catchment area for the mothership paradigm and a larger catchment area of DD paradigm compared with the drip-and-ship paradigm in Northwestern Germany in most scenarios. The existence of different paradigms allows the spread of capacities, shares the cost and hospital income, and gives primary stroke centers the possibility to provide endovascular therapy services 24/7.
Keywords: humans; probability; stroke; triage; workflow.
Modeling Stroke Patient Transport for All Patients With Suspected Large-Vessel OcclusionJK Holodinsky et al. JAMA Neurol 75 (12), 1477-1486. PMID 30193366.This study suggests that decision making for prehospital transport can be modeled using existing clinical trial data and that these models can be dynamically adapted to c …
Drip 'N Ship Versus Mothership for Endovascular Treatment: Modeling the Best Transportation Options for Optimal OutcomesMS Milne et al. Stroke 48 (3), 791-794. PMID 28100764.Drip 'n Ship demonstrates that a PSC that is in close proximity to a CSC remains significant only when the PSC is able to achieve a door-to-needle time of ≤30 minutes whe …
Two Paradigms for Endovascular Thrombectomy After Intravenous Thrombolysis for Acute Ischemic StrokeG Gerschenfeld et al. JAMA Neurol 74 (5), 549-556. PMID 28319240.This study found that patients treated under the drip-and-ship paradigm also benefit from bridging therapy, with no statistically significant difference compared with tho …
[Mothership or Drip and Ship?]J Fiehler. Radiologe 59 (7), 610-615. PMID 31069427. - ReviewBased on the unambiguous data situation, no recommendations can currently be made for a generally superior organizational model.
Stroke Transfer and Its Organizational Paradigm : Review of Organizational Paradigms and the Impact on OutcomeL Détraz et al. Clin Neuroradiol 28 (4), 473-480. PMID 30091041. - ReviewSince the clinical recognition of endovascular therapy (EVT) for stroke treatment is recent (2015), some organizational issues, such as the "drip and ship (DS) versus mot …