PDF(Pubmed)
Abstract：
BACKGROUND: Physician transfer is an alternate option to patient transfer for expedient performance of mechanical thrombectomy in patients with acute ischemic stroke.
RESULTS: We conducted a systematic review to identify studies that evaluate the effect of physician transfer in patients with acute ischemic stroke who undergo mechanical thrombectomy. A search of PubMed, Scopus, and Web of Science was undertaken, and data were extracted. A statistical pooling with random-effects meta-analysis was performed to examine the odds of reduced time interval between stroke onset and recanalization, functional independence, death, and angiographic recanalization. A total of 12 studies (11 nonrandomized observational studies and 1 nonrandomized controlled trial) were included, with a total of 1894 patients. Physician transfer was associated with a significantly shorter time interval between stroke onset and recanalization with a pooled mean difference estimate of -62.08 (95% CI, -112.56 to -11.61]; P=0.016; 8 studies involving 1419 patients) with high between-study heterogeneity in the estimates (I2=90.6%). The odds for functional independence at 90 days were significantly higher (odds ratio, 1.29 [95% CI, 1.00-1.66]; P=0.046; 7 studies with 1222 patients) with physician transfer with low between-study heterogeneity (I2=0%). Physician transfer was not associated with higher odds of near-complete or complete angiographic recanalization (odds ratio, 1.18 [95% CI, 0.89-1.57; P=0.25; I2=2.8%; 11 studies with 1856 subjects).
CONCLUSIONS: Physician transfer was associated with a significant reduction in the mean of time interval between symptom onset and recanalization and increased odds for functional independence at 90 days with physician transfer compared with patient transfer among patients who undergo mechanical thrombectomy.
RESULTS: We conducted a systematic review to identify studies that evaluate the effect of physician transfer in patients with acute ischemic stroke who undergo mechanical thrombectomy. A search of PubMed, Scopus, and Web of Science was undertaken, and data were extracted. A statistical pooling with random-effects meta-analysis was performed to examine the odds of reduced time interval between stroke onset and recanalization, functional independence, death, and angiographic recanalization. A total of 12 studies (11 nonrandomized observational studies and 1 nonrandomized controlled trial) were included, with a total of 1894 patients. Physician transfer was associated with a significantly shorter time interval between stroke onset and recanalization with a pooled mean difference estimate of -62.08 (95% CI, -112.56 to -11.61]; P=0.016; 8 studies involving 1419 patients) with high between-study heterogeneity in the estimates (I2=90.6%). The odds for functional independence at 90 days were significantly higher (odds ratio, 1.29 [95% CI, 1.00-1.66]; P=0.046; 7 studies with 1222 patients) with physician transfer with low between-study heterogeneity (I2=0%). Physician transfer was not associated with higher odds of near-complete or complete angiographic recanalization (odds ratio, 1.18 [95% CI, 0.89-1.57; P=0.25; I2=2.8%; 11 studies with 1856 subjects).
CONCLUSIONS: Physician transfer was associated with a significant reduction in the mean of time interval between symptom onset and recanalization and increased odds for functional independence at 90 days with physician transfer compared with patient transfer among patients who undergo mechanical thrombectomy.
摘要：
背景：医师转诊是急性缺血性卒中患者机械取栓的另一种转诊选择。
结果：我们进行了一项系统综述，以确定评估医师转诊对接受机械血栓切除术的急性缺血性卒中患者的影响的研究。搜索PubMed,Scopus,WebofScience进行了研究，并提取数据。进行了随机效应荟萃分析的统计汇总，以检查中风发作和再通之间时间间隔缩短的几率。功能独立，死亡,血管造影再通.共纳入12项研究（11项非随机观察性研究和1项非随机对照试验），共有1894名患者。医师转移与卒中发作和再通之间的时间间隔明显缩短相关，合并平均差异估计为-62.08（95％CI，-112.56至-11.61]；P=0.016；8项研究涉及1419名患者），研究间的异质性高（I2=90.6％）。90天时功能独立性的几率明显更高(赔率比，1.29[95%CI，1.00-1.66]；P=0.046；7项研究，1222例患者），医生转移，研究间异质性低（I2=0%）。医师转移与接近完全或完全血管造影再通的较高几率无关（优势比，1.18[95%CI，0.89-1.57；P=0.25；I2=2.8%；11项研究，1856名受试者）。
结论：在接受机械血栓切除术的患者中，医师转诊与症状发作和再通之间的平均时间间隔显著缩短，并且与患者转诊相比，医师转诊后90天的功能独立性几率增加。
结果：我们进行了一项系统综述，以确定评估医师转诊对接受机械血栓切除术的急性缺血性卒中患者的影响的研究。搜索PubMed,Scopus,WebofScience进行了研究，并提取数据。进行了随机效应荟萃分析的统计汇总，以检查中风发作和再通之间时间间隔缩短的几率。功能独立，死亡,血管造影再通.共纳入12项研究（11项非随机观察性研究和1项非随机对照试验），共有1894名患者。医师转移与卒中发作和再通之间的时间间隔明显缩短相关，合并平均差异估计为-62.08（95％CI，-112.56至-11.61]；P=0.016；8项研究涉及1419名患者），研究间的异质性高（I2=90.6％）。90天时功能独立性的几率明显更高(赔率比，1.29[95%CI，1.00-1.66]；P=0.046；7项研究，1222例患者），医生转移，研究间异质性低（I2=0%）。医师转移与接近完全或完全血管造影再通的较高几率无关（优势比，1.18[95%CI，0.89-1.57；P=0.25；I2=2.8%；11项研究，1856名受试者）。
结论：在接受机械血栓切除术的患者中，医师转诊与症状发作和再通之间的平均时间间隔显著缩短，并且与患者转诊相比，医师转诊后90天的功能独立性几率增加。
