Drip-and-Ship for Thrombectomy Treatment in Patients With Acute Ischemic Stroke Leads to Inferior Clinical Outcomes in a Stroke Network Covering Vast Rural Areas Compared to Direct Admission to a Comprehensive Stroke Center.

Introduction: Organizing regional stroke care considering thrombolysis as well as mechanical thrombectomy (MTE) remains challenging in light of a wide range of regional population distribution. To compare outcomes of patients in a stroke network covering vast rural areas in southwestern Germany who underwent MTE via direct admission to a single comprehensive stroke center [CSC; mothership (MS)] with those of patients transferred from primary stroke centers [PSCs; drip-and-ship (DS)], we undertook this analysis of consecutive stroke patients with MTE. Materials and Methods: Patients who underwent MTE at the CSC between January 2013 and December 2016 were included in the analysis. The primary outcome measure was 90-day functional independence [modified Rankin score (mRS) 0-2]. Secondary outcome measures included time from stroke onset to recanalization/end of MTE, angiographic outcomes, and mortality rates. Results: Three hundred and thirty-two consecutive patients were included (MS 222 and DS 110). Median age was 74 in both arms of the study, and there was no significant difference in baseline National Institutes of Health Stroke Scale scores (median MS 15 vs. 16 DS). Intravenous (IV) thrombolysis (IVT) rates differed significantly (55% MS vs. 70% DS, p = 0.008). Time from stroke onset to recanalization/end of MTE was 112 min shorter in the MS group (median 230 vs. 342 min, p < 0.001). Successful recanalization [thrombolysis in cerebral infarction (TICI) 2b-3] was achieved in 72% of patients in the MS group and 73% in the DS group. There was a significant difference in 90-day functional independence (37% MS vs. 24% DS, p = 0.017), whereas no significant differences were observed for mortality rates at 90 days (MS 22% vs. DS 17%, p = 0.306). Discussion: Our data suggest that patients who had an acute ischemic stroke admitted directly to a CSC may have better 90-day outcomes than those transferred secondarily for thrombectomy from a PSC.

General surgery among long-term residents with and without active epilepsy at the Kork Epilepsy Centre - a prospective comparative one-year survey.

BACKGROUND/AIMS: We prospectively assessed the frequency, type, severity and cause of treatment among the long-term residents of the Kork Epilepsy Centre in the year 2005. METHODS: All long-term residents were exclusively referred to the general surgeon practicing on the campus. Patients were divided into 2 groups comprising 285 patients with active epilepsy and 53 controls who either never had epileptic seizures or have remained seizure free for at least 4 years. RESULTS: The 1-year incidence of injuries was 54.2% among the active epilepsy group and 36.8% among controls (p = 0.0275). Several admissions due to differing reasons occurred in 16.8% of people with active epilepsy and in 7.5% of the controls (not significant). More than 2 admissions due to various reasons only occurred in patients with active epilepsy (range 3-9). Of all injuries, 41.3% were directly related to seizures. Among patients with active epilepsy, the 3 most frequent injuries were lacerations, bruises and fractures (29.6, 17.0 and 11.7%, respectively). CONCLUSION: According to this prospective study, active epilepsy turned out to be a significant risk factor for injuries under homogenous patient and observer conditions.