Simulation modelling to study the impact of adding comprehensive stroke centres. Can we deliver endovascular thrombectomy sooner?

Willemijn Maas, Durk Jouke Van Der Zee, Erik Buskens, CONTRAST investigators, Maarten Uyttenboogaart, M Lahr, Diederik Dippel, C.B.M. Majoie, H.M.M. van Beusekom, Hugo ten Cate, R. Dammers, Rick M. Dijkhuizen, L. Jaap Kappelle, Catharina J.M. Klijn, Peter Koudstaal, Hester Lingsma, Aad van der Lugt, Moniek de Maat, Paul J. Nederkoorn, Robert J. van OostenbruggeYvo B.W.E.M. Roos, Denis Vivian, Wim H. van Zwam

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Abstract

Objectives: Regional accessibility and distribution of endovascular thrombectomy (EVT) capable facilities, that is, comprehensive stroke centres (CSCs), may significantly influence time to treatment. We analysed the impact of adding CSCs in the north of the Netherlands, a region with roughly 1.7 million inhabitants currently served by one CSC and eight primary stroke centres (PSCs).

Design: Monte Carlo simulation modelling was used to establish new CSCs in our region by hypothetically upgrading existing PSCs to CSCs and ensuing adjustments in health services set-up.

Setting: One CSC and eight PSCs in the north of the Netherlands.

Participants: 165 patients with acute stroke treated with EVT and underwent interhospital transfer between PSC and CSC (drip and ship patients).

Primary and secondary outcomes: Time from onset to groin (OTG) puncture and predicted probability of favourable outcome (modified Rankin Scale 0-2) after 90 days. Sensitivity analyses were performed to assess uncertainty in workflow efficiency of CSCs.

Results: Adding one or two CSCs would reduce the OTG time up to approximately 17 min and increases the predicted probability of favourable outcome by approximately 2%. Sensitivity analyses revealed that 'slow-acting' CSCs may reduce OTG by 3-5 min compared with 24-32 min for 'fast-acting' CSCs.

Conclusions: This study suggests that adding one or two CSCs in the north of the Netherlands would have modest impact. Improving workflow efficiencies seems to be more potent when aiming to improve existing acute stroke care systems.
Original languageEnglish
Article numbere068749
JournalBMJ Open
Volume13
Issue number7
DOIs
Publication statusPublished - 24 Jul 2023

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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