{
  "abstract": "Background While endovascular thrombectomy (EVT) has revolutionized the treatment of acute large vessel occlusions, the appropriate patient transfer paradigm remains controversial. This study compares outcomes of three transfer models in a stroke network: mothership (MS), traditional drip-and-ship (DS), and an integrated DS model using a novel transfer system (TS).Methods We implemented a novel TS to streamline communication and coordination between primary and comprehensive stroke centers. We analyzed 1063 patients with suspected large vessel occlusion across three groups: MS (n=814), conventional DS without TS (DS TS (−), n=185), and DS with TS (DS TS (+), n=64). Primary outcomes included treatment time metrics, EVT rates, and functional outcomes.Results DS TS (+) showed improved time metrics, with onset-to-CT angiography (CTA) times comparable to MS (232 vs 255.5 min) and significantly faster than DS TS (−) (305 min). It also achieved the highest rates of both intravenous thrombolysis (51.56%) and EVT (48.44%). Among EVT patients, the DS TS (+) group had the shortest door-to-puncture time (98.0 min vs MS 132.0 min and DS TS (−) 127.0 min, P<0.001) and a shorter onset-to-puncture time compared with the DS TS (−) group. DS TS (+) also showed a promising trend towards superior functional outcomes at 3 months (modified Rankin Scale score 0–2: 54.84% vs MS 39.10% vs DS TS (−) 36.36%).Conclusion This study shows that an integrated DS model using a structured TS can achieve outcomes comparable to the MS model. Enhancing transfer efficiency through innovative solutions tailored to the regional infrastructure may serve as a viable alternative alongside the MS model.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan"
      ],
      "name": "Chun-Min Wang"
    },
    {
      "affiliations": [
        "Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan"
      ],
      "name": "Che-Wei Lin"
    },
    {
      "affiliations": [
        "Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan"
      ],
      "name": "Yu-Ming Chang"
    },
    {
      "affiliations": [
        "Department of Neurology, Tainan Municipal Hospital, Tainan City, Taiwan"
      ],
      "name": "Ray-Chang Tzeng"
    },
    {
      "affiliations": [
        "Department of Neurology, Chi Mei Hospital Liou Ying, Liouying District, Taiwan"
      ],
      "name": "Ming-Hsiu Wu"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Chi Mei Hospital Liou Ying, Liouying District, Taiwan"
      ],
      "name": "Si-Chon Vong"
    },
    {
      "affiliations": [
        "Department of Neurology, Tainan Sin-Lau Hospital, Tainan City, Taiwan"
      ],
      "name": "Tsang-Shan Chen"
    },
    {
      "affiliations": [
        "Department of Neurology, Kuo General Hospital, Tainan City, Taiwan"
      ],
      "name": "Shang-Te Wu"
    },
    {
      "affiliations": [
        "Department of Neurology, St Martin De Porres Hospital, Chiayi, Taiwan"
      ],
      "name": "Yu-Tai Tsai"
    },
    {
      "affiliations": [
        "Department of Neurology, Xinhua Branch, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan"
      ],
      "name": "Yi-Ting Fang"
    },
    {
      "affiliations": [
        "Department of Neurology, Madou Sin-Lau Hospital, the Presbyterian Church, Tainan, Taiwan"
      ],
      "name": "Chuang-Chou Yang"
    },
    {
      "affiliations": [
        "Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan"
      ],
      "name": "Yu-Hsiang Su"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Kaohsiung Veterans General Hospital Tainan Branch, Yongkang District, Taiwan"
      ],
      "name": "Meng-Hua Huang"
    },
    {
      "affiliations": [
        "Department of Neurology, Tainan Hospital Ministry of Health and Welfare, Tainan City, Taiwan"
      ],
      "name": "Mu-Han Wu"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Chi Mei Hospital Chiali, Tainan City, Taiwan"
      ],
      "name": "Feng-Yuan Chu"
    },
    {
      "affiliations": [
        "Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan"
      ],
      "name": "Yen-Chu Huang"
    },
    {
      "affiliations": [
        "Department of Neurology, Chi Mei Medical Center, Yongkang District, Taiwan"
      ],
      "name": "Kuan-Hung Lin"
    },
    {
      "affiliations": [
        "Division of Neurosurgery, Department of Surgery, Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan"
      ],
      "name": "Che-Chao Chang"
    },
    {
      "affiliations": [
        "Institute of Clinical Medicine, National Cheng Kung University College of Medicine, Tainan City, Taiwan",
        "Biostatistics Consulting Center, College of Medicine National Cheng Kung University, Tainan City, Taiwan"
      ],
      "name": "Sheng‐Hsiang Lin"
    },
    {
      "affiliations": [
        "Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan"
      ],
      "name": "Pi-Shan Sung"
    }
  ],
  "title": "Integrated drip-and-ship improves stroke transfer efficiency and outcomes: a comparison with traditional drip-and-ship and mothership models",
  "uid": "92f0e8fc-ca52-53cd-ae7b-044fc8e33a1c"
}