Abstract Details

Title A Travel Time and Efficiency Simulation for Patient Transport to Primary and Comprehensive Stroke Centers

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S52 - Acute Non-Interventional Stroke Care (4:03 PM-4:14 PM)

Poster/Presentation
Number 004

Background New model for prehospital triage offers a theoretical quicker access to thrombectomy to a cohort of patients. The conditions necessary for its success are unclear.

Objective To identify the conditions in which bypassing a near Primary Stroke Center (PSC) to go straight to a further Comprehensive Stroke Center (CSC) leads to shorter time to stroke treatment.

Design/Methods Three simulations were performed. The first simulation evaluated time to IV Alteplase, taking into account travel and door-to-needle (DTN) times. The second and third simulation evaluated time to thrombectomy and accounted for travel, door-in-door-out, and door-to-groin (DTG) times. We considered CTA as available at PSC in one simulation and as unavailable in the other. In all simulations, we assumed that thrombectomy can only happen at the CSC. Regarding travel time, we implemented a rule that the longest distance between the three points of interest must be within three times the sum of the two smaller distances to be considered feasible.

Results

For the first simulation, in 46.6% of cases DTN was faster going to the PSC. This occurred when the combination of travel time and PSC efficiency outweighed those elements at the CSC.

For the second simulation, assuming CTA is not available at PSC, DTG was better going straight to CSC in the vast majority (96.4%) of cases.

For the third, if CTA can be done at either hospital, going to PSC first was favored in a small number of cases (10.5%).

Conclusions This study illustrates that an efficient PSC with CTA capability would lead to faster DTN and DTG times. A universal prehospital triaging model would not benefit all patients in all scenarios if it is only based on time to reach destination hospital. Such a model should take into account the quality of care and the available resources in the community.

Authors/Disclosures
Haitham Hussein, MD, FAAN (University of Minnesota Medical School) PRESENTER	Dr. Hussein has nothing to disclose.
	No disclosure on file
	No disclosure on file

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