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

Date Published: 2023-07-24

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.

Introduction:
Fast treatment of acute ischaemic stroke (AIS) due to large vessel occlusion (LVO) is pivotal to improve functional outcome. 1 The effects of both intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) for AIS are highly time dependent. that is, every hour delay implies a 5%–6% decline in the chance of a favourable outcome. 2 3 Two main organisational models for acute stroke care currently exist. In the mothership (MS) model, a patient with suspected stroke is directly transported to a comprehensive…

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