AI-enhanced pathway reorganization in drip-and-ship stroke management: Italian MDRinAIS experience
Abstract
Background and Aims: The MDRinAIS project is an EU-funded initiative to optimize acute ischemic stroke (AIS) care through AI-powered telemedicine in the drip-and-ship model. Beyond AI implementation, the pathway was reorganized to enable direct hub admission to the Neuroradiology Unit, bypassing the emergency department. This study evaluates the impact of this integrated reorganization on time metrics and clinical outcomes in South-East Tuscany.
Methods: This cohort study included 277 AIS patients with large vessel occlusion treated via drip-and-ship: pre-reorganization (n = 214, 2018–2021) and post-reorganization (n = 78, 2025–2026). Key time metrics assessed were door-to-groin (DTG) and spoke admission-to-hub puncture (DT). Clinical outcomes included 24h NIHSS and 3-month mRS. Mann-Whitney U test; p < 0.05.
Results: Cohorts were comparable at baseline for age, sex, risk factors and baseline NIHSS. The post-reorganization group showed significantly shorter in-hospital time metrics: DTG (40 vs 58min; p < 0.001), DT (212 vs 240 min; p < 0.001). Pre-hospital intervals, including onset-to-door and door-to-fibrinolysis, were comparable between groups. Early neurological recovery was significantly better in the post-reorganization cohort (24h NIHSS 7 vs 13; p = <0.001), with a trend toward lower discharge NIHSS (3 vs 6; p = 0.015). At 3 months, functional independence improved significantly (mRS 1 vs 3; p = 0.018), with reduced moderate-to-severe disability (mRS 3–6: 42.9% vs 61.7%; p = 0.024). Reperfusion rates and safety profiles, including hemorrhagic complications, were comparable between cohorts.
Conclusions: Integrated pathway reorganization combining AI-powered telemedicine and direct Neuroradiology admission was associated with reduced in-hospital time metrics and improved clinical outcomes. These findings support the value of system-level innovation in stroke network optimization.
Key messages: • Integrating AI-powered telemedicine with direct admission to the Neuroradiology Unit significantly reduces in-hospital treatment times in drip-and-ship stroke care.
• This system-level reorganization, in a rural low density area, translates into improved clinical outcomes, including improved early neurological recovery and higher rates of functional independence.
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BibTeX
@article{vitiello2026aienhanced,
title = {{AI-enhanced pathway reorganization in drip-and-ship stroke management: Italian MDRinAIS experience}},
author = {M Vitiello and S Lo Conte and M Zanoni and L De Stefano and R Tassi and G Semjonova and R Mospan and D Del Roscio and S Guerrini and S Bracco},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.330},
url = {https://doi.org/10.1093/eurpub/ckag169.330},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - AI-enhanced pathway reorganization in drip-and-ship stroke management: Italian MDRinAIS experience
AU - M Vitiello
AU - S Lo Conte
AU - M Zanoni
AU - L De Stefano
AU - R Tassi
AU - G Semjonova
AU - R Mospan
AU - D Del Roscio
AU - S Guerrini
AU - S Bracco
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.330
UR - https://doi.org/10.1093/eurpub/ckag169.330
AB - Background and Aims: The MDRinAIS project is an EU-funded initiative to optimize acute ischemic stroke (AIS) care through AI-powered telemedicine in the drip-and-ship model. Beyond AI implementation, the pathway was reorganized to enable direct hub admission to the Neuroradiology Unit, bypassing the emergency department. This study evaluates the impact of this integrated reorganization on time metrics and clinical outcomes in South-East Tuscany. Methods: This cohort study included 277 AIS patients with large vessel occlusion treated via drip-and-ship: pre-reorganization (n = 214, 2018–2021) and post-reorganization (n = 78, 2025–2026). Key time metrics assessed were door-to-groin (DTG) and spoke admission-to-hub puncture (DT). Clinical outcomes included 24h NIHSS and 3-month mRS. Mann-Whitney U test; p < 0.05. Results: Cohorts were comparable at baseline for age, sex, risk factors and baseline NIHSS. The post-reorganization group showed significantly shorter in-hospital time metrics: DTG (40 vs 58min; p < 0.001), DT (212 vs 240 min; p < 0.001). Pre-hospital intervals, including onset-to-door and door-to-fibrinolysis, were comparable between groups. Early neurological recovery was significantly better in the post-reorganization cohort (24h NIHSS 7 vs 13; p = <0.001), with a trend toward lower discharge NIHSS (3 vs 6; p = 0.015). At 3 months, functional independence improved significantly (mRS 1 vs 3; p = 0.018), with reduced moderate-to-severe disability (mRS 3–6: 42.9% vs 61.7%; p = 0.024). Reperfusion rates and safety profiles, including hemorrhagic complications, were comparable between cohorts. Conclusions: Integrated pathway reorganization combining AI-powered telemedicine and direct Neuroradiology admission was associated with reduced in-hospital time metrics and improved clinical outcomes. These findings support the value of system-level innovation in stroke network optimization. Key messages: • Integrating AI-powered telemedicine with direct admission to the Neuroradiology Unit significantly reduces in-hospital treatment times in drip-and-ship stroke care. • This system-level reorganization, in a rural low density area, translates into improved clinical outcomes, including improved early neurological recovery and higher rates of functional independence.
SN - 1101-1262
SN - 1464-360X
ER -