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Original research
Electronic Alberta Stroke Program Early CT score change and functional outcome in a drip-and-ship stroke service
  1. Jan Christoph Purrucker1,
  2. Nicole Mattern1,
  3. Christian Herweh2,
  4. Markus Möhlenbruch2,
  5. Peter Arthur Ringleb1,
  6. Simon Nagel1,
  7. Christoph Gumbinger1
  1. 1 Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
  2. 2 Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
  1. Correspondence to Dr. Christoph Gumbinger; christoph.gumbinger{at}


Background Debate continues as to whether patients with acute ischemic stroke with (suspected) large vessel occlusion benefit from direct referral versus secondary transportation.

Aims To analyze the change in early infarct signs, collaterals, and acute ischemia volume and their association with transfer time and functional outcome.

Methods We retrospectively analyzed consecutive transfers between 2013 and 2016 for patients with anterior circulation stroke transported from referring hospitals to our center as potential candidates for thrombectomy. Alberta Stroke Programme Early CT Scores (ASPECTS) were automatically calculated on external and in-house CT using the Brainomix e-ASPECTS software, and collaterals were assessed using the e-CTA tool. Functional status after stroke using the modified Rankin scale (mRS) was obtained.

Results 102 patients with CT scans both at the referring hospital and our center were identified. During patient transfer, e-ASPECTS declined by a median of 1 point (0–2). Functional outcome correlated with the change in e-ASPECTS (decline, n=54) (Spearman rs =0.322, 95% CI 0.131 to 0.482, p=0.001). The median image-to-image time was 149 min (IQR 113–190), but did not correlate with change in e-ASPECTS (p=0.754) and mRS score at 3 months (p=0.25). Preserved good collateral status assessed at the comprehensive stroke center was associated with better functional outcome (rs =−0.271, 95% CI −0.485 to −0.037, p=0.02).

Conclusions Patient transfer in a drip-and-ship network was associated with declines in e-ASPECTS associated with worse functional outcome. Image-to-image time did not influence this association, but worsening collateral status did.

  • stroke
  • ct angiography
  • thrombolysis
  • thrombectomy

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  • SN and CG contributed equally.

  • Contributors Study concept and design: JCP, CG, SN. Acquisition, analysis or interpretation of data: all authors. JCP wrote the first draft of the manuscript. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: JCP, NM, CG.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JCP has received consultation fees and travel expenses from Akcea, Boehringer Ingelheim, and Pfizer. CH received consultation fees and travel expenses from Brainomix Ltd. MM reports consultation fees from Medtronic, MicroVention, Stryker, and grants/grants pending from Balt, MicroVention (money paid to the institution), and payment for lectures including service on speaker bureaus from Medtronic, MicroVention, Stryker. PAR received travel support and lecture fee from Boeheringer Ingelheim, Daiichi Sankyo, Pfizer, Bayer. SN has received consulting fees from Brainomix and Boehringer Ingelheim, and lecture fees and travel expenses from Medtronic and Pfizer.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data that support the findings of this study are available from the corresponding author upon reasonable request.

  • Patient consent for publication Not required.