e-Article
Simulation modelling to study the impact of adding comprehensive stroke centres. Can we deliver endovascular thrombectomy sooner?
Document Type
article
Author
Maarten Uyttenboogaart; Hester Lingsma; Jaap Kappelle; Karin Klijn; Willemijn J Maas; Durk-Jouke van der Zee; Erik Buskens; Paul Nederkoorn; Aad van der Lugt; Diederik Dippel; Charles Majoie; Yvo Roos; Robert van Oostenbrugge; Wim van Zwam; Ruben Dammers; Peter Koudstaal; Hugo Ten Cate; Moniek de Maat; Heleen van Beusekom; Maarten MH Lahr; Rick Dijkhuizen; Denis Vivian
Source
BMJ Open, Vol 13, Iss 7 (2023)
Subject
Language
English
ISSN
2044-6055
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.