{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:25:49Z","timestamp":1787646349891,"version":"build-2736575974"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute ischemic stroke requires urgent treatment, yet geographic disparities in specialized care necessitate two transport strategies: direct transfer to comprehensive stroke centers (mothership, MS) versus initial treatment at primary centers followed by transfer (drip-and-ship, DS). Optimal routing remains uncertain, particularly with extended treatment time windows.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis adhering to PRISMA\/MOOSE guidelines. Literature search of PubMed, Embase, and Cochrane through October 17, 2025, identified comparative studies evaluating MS versus DS in acute stroke. Outcomes included 90-day functional independence (mRS 0-2), symptomatic intracranial hemorrhage (sICH), reperfusion success (TICI 2b-3), and 90\u202fdays mortality. Random-effects models pooled odds ratios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-eight observational studies (10,059 patients) were included; no randomized controlled trial met the final inclusion criteria. MS demonstrated superior functional independence (OR 0.83, 95%CI 0.73\u20130.95,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.008), with stronger effects in prospective studies. No mortality difference was observed (OR 1.05, 95%CI 0.92\u20131.21). MS significantly increased hemorrhage risk (OR 1.41, 95%CI 1.12\u20131.77,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.003). Reperfusion rates did not differ between models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The mothership model improves functional outcomes but elevates hemorrhage risk without mortality benefit. Direct transport to comprehensive stroke centers is recommended when geographically feasible, accompanied by intensive post-procedural monitoring. Rural settings require tailored, context-specific strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1941406","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T07:51:44Z","timestamp":1787644304000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Latest evidence on transfer efficiency and patient outcomes in mothership versus drip-and-ship models for acute stroke management: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Fei","family":"Zhang","sequence":"first","affiliation":[{"name":"Clinical Medical College, Qinghai University","place":["Xining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunlan","family":"Tian","sequence":"additional","affiliation":[{"name":"Lvliang Maternal and Child Health and Family Planning Service Center, Lvliang Maternal and Child Health Hospital","place":["Lvliang, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Wu","sequence":"additional","affiliation":[{"name":"Clinical Medical College, Qinghai University","place":["Xining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Qinghai Provincial People's Hospital","place":["Xining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Diseases, Henan Provincial People's Hospital, Henan Provincial People's Clinical Medical School of Zhengzhou University","place":["Zhengzhou, 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