Redistributing medical resources for a bypass strategy for large vessel occlusion: A community-based study
Journal
Journal of NeuroInterventional Surgery
Journal Volume
12
Journal Issue
1
Pages
98-103
Date Issued
2020
Author(s)
Liu T.-Y.
Wang C.-H.
Lee Y.-C.
Abstract
Background A bypass strategy for large vessel occlusion (LVO) benefits patients receiving endovascular thrombectomy (EVT), but may delay some patients from receiving IV thrombolysis. However, patient centralization has been shown to improve outcomes. Objective To understand the current coverage of medical services for patients with stroke, and to identify the best coverage under different medical resource redistribution to help balance medical equality and patient centralization. Methods This 6-year geographic study of 7679 on-scene patients with suspected stroke with a positive Cincinnati Prehospital Stroke Scale (CPSS) score identified 4037 patients with all three CPSS items who were suspected as having an LVO. Geographic, population, and patient coverage rates for hospitals providing IV thrombolysis and those providing EVT were identified according to hospital service areas, defined as geographic districts with access to a hospital within a ?15 min off-peak driving time estimated using Google Maps. Moreover, we estimated the effects on resource redistribution when implementing a bypass strategy. Results Geographic coverage rates for hospitals providing IV thrombolysis and those providing EVT were 64.75% and 56.62%, respectively, and population coverage rates were 97.30% and 92.72%, respectively. The service areas of hospitals providing IV thrombolysis covered 93.77% of patients with suspected stroke, and those of hospitals providing EVT covered 87.89% of patients with suspected LVO. The number of hospitals providing IV thrombolysis and those providing EVT could be reduced to six and two hospitals, respectively, without affecting hospital arrival time when implementing a bypass strategy. Conclusion Hospitals providing IV thrombolysis and EVT could be reduced without reducing medical equality. ? Author(s) (or their employer(s)) 2020.
SDGs
Other Subjects
alteplase; fibrinolytic agent; tissue plasminogen activator; adolescent; adult; aged; Article; blood clot lysis; centralization; Cincinnati Prehospital Stroke Scale; community; controlled study; female; geography; health care access; health service; hospital; human; major clinical study; male; medical society; occlusive cerebrovascular disease; patient identification; percutaneous thrombectomy; priority journal; resource allocation; socioeconomics; United States; brain ischemia; cerebrovascular accident; endovascular surgery; independent living; intravenous drug administration; Ohio; procedures; resource allocation; thrombectomy; time to treatment; Administration, Intravenous; Brain Ischemia; Endovascular Procedures; Female; Humans; Independent Living; Male; Ohio; Resource Allocation; Stroke; Thrombectomy; Time-to-Treatment; Tissue Plasminogen Activator
Type
journal article