In Reply We thank Uchino for his letter on our recently published article1 in which he discusses potential limitations of our study. The first criticism concerns the unexpected less favorable outcome in the mothership (MS) group despite significantly shorter onset-to-needle and onset-to-recanalization times. It is true that even though the difference was not statistically significant, the MS group had fewer patients with a 3-month favorable functional outcome (50.8%) when compared with the drip-and-ship (DS) group (61 [61.0%]; P = .26). As we mentioned in our article, patients in the MS group had slightly but significantly more severe conditions, which could be attributable to an implicit recruitment bias favored by the presence in the MS of a neurosurgery department and a neurologic intensive care unit.
Gerschenfeld G, Alamowitch S. Presenting to Primary Stroke Centers or Comprehensive Stroke Centers for Thrombolysis—Reply. JAMA Neurol. Published online August 21, 2017. doi:10.1001/jamaneurol.2017.2018