Introduction There is controversy if direct to comprehensive center “mothership” (MS) or

stopping at primary center for thrombolysis before transfer to comprehensive center “drip-and-

ship” (DS) are best models of treatment of acute stroke. In this study, we compare MS and DS models to evaluate the best option of functional outcome.

Methods Studies between 1990 and 2020 were extracted from online electronic databases. We compared the clinical outcomes, critical time measurements, functional independence and mortality were then compared.

Results A total of 7,824 patients’ data were retrieved from 13 publications (3 randomized control trials and 10 retrospective ones). 4,639 (59.3%) patients were treated under MS model and 3,185 (40.7%) followed the DS model with mean age of 70.01±3.58 vs. 69.03±3.36; p< 0 .001, respectively. The National Institute Health Stroke Scale was 15.57±3.83 for the MS and 15.72±2.99 for the DS model (p=<0.001). The mean symptoms onset-to-puncture time was significantly shorter in the MS group compared to the DS (159.69 min vs. 223.89 min; p=<0.001, respectively). Moreover, the collected data indicated no significant difference between symptom’s onset to intravenous (IV) thrombolysis time and stroke onset-to-successful recanalization time (p=0.205 and p=<0.001, respectively). Patients had significantly worse functional outcome [modified rankin score (mRS)] (3-6) at 90-days in the DS model [Odds Ratio (OR): 1.47, 95% Confidence Interval (CI): 1.13-1.92, p<0.004] and 1.49-folds higher likelihood of symptomatic intracerebral hemorrhage (OR: 1.49, 95%CI: 1.22-1.81, p<0.0001) compared to MS. However, there were no statistically significant difference in terms of mortality (OR: 1.16, 95%CI: 0.87-1.55, p=0.32) and successful recanalization (OR: 1.12, 95%CI: 0.76-1.65, p=0.56) between the two models of care.

Conclusion Patients in the MS model have significantly improved functional independence and recovery. Further studies are needed as the data from prospectively randomized studies is not of sufficient quality to make definite recommendations.

引言 如果直接到综合中心“母性”（MS）或

在转移到综合中心之前在初级中心进行溶栓治疗

ship? (DS) 是治疗急性中风的最佳模型。在这项研究中，我们比较了 MS 和 DS 模型来评估功能结果的最佳选择。

方法 从在线电子数据库中提取 1990 年至 2020 年的研究。我们比较了临床结果、关键时间测量、功能独立性和死亡率。

结果 从 13 篇出版物（3 项随机对照试验和 10 项回顾性试验）中检索到总共 7,824 名患者的数据。4,639 (5​​9.3%) 名患者接受 MS 模型治疗，3,185 (40.7%) 名患者接受 DS 模型，平均年龄分别为 70.01±3.58 对 69.03±3.36；p < 0 .001，分别。国家研究所健康中风量表为 MS 15.57±3.83 和 DS 模型 15.72±2.99 (p = <0.001)。与 DS 组相比，MS 组的平均症状发作至穿刺时间显着缩短（分别为 159.69 分钟和 223.89 分钟；p=<0.001）。此外，收集的数据表明症状发作至静脉内 (IV) 溶栓时间和卒中发作至成功再通时间之间没有显着差异（分别为 p=0.205 和 p=<0.001）。在 DS 模型中，患者在 90 天时的功能结果 [改良 rankin 评分 (mRS)] (3-6) [优势比 (OR): 1.47, 95% 置信区间 (CI): 1.13-1.92, p< 0.004]，与 MS 相比，出现症状性脑出血的可能性高 1.49 倍（OR：1.49，95%CI：1.22-1.81，p<0.0001）。然而，在死亡率（OR：1.16，95%CI：0.87-1.55，p=0.32）和成功再通（OR：1.12，95%CI：0.76-1.65，p=0.56）之间没有统计学上的显着差异两种护理模式。

结论 MS 模型患者的功能独立性和恢复能力显着提高。需要进一步的研究，因为来自前瞻性随机研究的数据质量不足以提出明确的建议。