Abstract Details

Title Potential Biases in Patients Selected for Drip and Ship Thrombolysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 053

Objective

Background BACKGROUND: The drip and ship model is a method to deliver thrombolysis to acute stroke patients in facilities lacking onsite neurology coverage. To date, no study has examined if there are biases in how patients are selected for this treatment.

Design/Methods DESIGN/METHODS: We retrospectively reviewed consecutive patients who received thrombolysis at an outside facility with subsequent transfer to our stroke center between 2009 and 2011. Patients received thrombolysis after telephone consultation with a stroke specialist. We examined demographics, vascular risk factors, laboratory values, stroke severity and short term outcomes including risk of symptomatic intracerebral hemorrhage (sICH).

Results RESULTS: Ninety-six patients were identified who received thrombolysis by drip and ship: median NIHSS 9 (IQR 4, 15) vs 8 (IQR 5, 14) in direct presenters (p=0.368). The two groups did not differ with respect to gender, ethnicity, vascular risk factors, admission glucose, or smoking history. The drip and ship median age was 63 (IQR: 50, 75) compared to 68 (IQR: 55, 82) in direct presenters (p <0.001). The odds ratio (OR) of arriving at our hospital as a drip and ship for someone >80 was 0.31 (CI 0.15-0.61, p<0.001). Furthermore, 21% of drip and ships were Black vs 38% of direct presenters (OR 0.434, 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 CI 0.24-0.81, p=0.008).

Conclusions CONCLUSIONS: Our study showed a smaller proportion of Blacks and elderly in the drip and ship population compared to direct presenters. This may be due to a failure to present within a treatment window or may represent a bias in patient selection for transfer to a higher level of care.

Authors/Disclosures
Michael J. Lyerly, MD, FAAN (University of Alabama At Birmingham) PRESENTER	Dr. Lyerly has nothing to disclose.
Karen C. Albright, DO, DO, PhD, MS, MPH (FDA)	Dr. Albright has nothing to disclose.
	No disclosure on file
Amelia K. Boehme, PhD (Columbia University)	Dr. Boehme has nothing to disclose.
	No disclosure on file
James T. Houston, MD	No disclosure on file
Pawan V. Rawal, MD	No disclosure on file
	No disclosure on file
Muhammad M. Alvi, MD, FAAN (West Virginia University)	Dr. Alvi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Brainomix.
	No disclosure on file
Anne Alexandrov	Anne Alexandrov has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. The institution of Anne Alexandrov has received research support from National Institutes of Health.
Andrei V. Alexandrov, MD (Department of Neurology, UTHSC)	The institution of Dr. Alexandrov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NovaSignal. Dr. Alexandrov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NovoNordisc. Dr. Alexandrov has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AstraZeneca. Dr. Alexandrov has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for American Society of Neuroimaging. Dr. Alexandrov has received publishing royalties from a publication relating to health care.

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