Type

Journal Article

Authors

David Williams
Michael D Hill
Joseph Harbison
Paul Marsden
Joan McCormack
Gerald Wyse
Seamus Looby
Barry Moynihan
Dominick JH McCabe
Alan O'Hare
and 12 others

Subjects

Architecture

Topics
future planning transport direct acute ischaemic stroke ireland treatment planning system decision making

Drip and ship versus direct to endovascular thrombectomy: The impact of treatment times on transport decision-making. (2017)

Abstract In ischaemic stroke care, fast reperfusion is essential for disability free survival. It is unknown if bypassing thrombolysis centres in favour of endovascular thrombectomy (mothership) outweighs transport to the nearest thrombolysis centre for alteplase and then transfer for endovascular thrombectomy (drip-and-ship). We use conditional probability modelling to determine the impact of treatment times on transport decision-making for acute ischaemic stroke. Probability of good outcome was modelled using a previously published framework, data from the Irish National Stroke Register, and an endovascular thrombectomy registry at a tertiary referral centre in Ireland. Ireland was divided into 139 regions, transport times between each region and hospital were estimated using Google's Distance Matrix Application Program Interface. Results were mapped using ArcGIS 10.3. Using current treatment times, drip-and-ship rarely predicts best outcomes. However, if door to needle times are reduced to 30 min, drip-and-ship becomes more favourable; even more so if turnaround time (time from thrombolysis to departure for the endovascular thrombectomy centre) is also reduced. Reducing door to groin puncture times predicts better outcomes with the mothership model. This is the first case study modelling pre-hospital transport for ischaemic stroke utilising real treatment times in a defined geographic area. A moderate improvement in treatment times results in significant predicted changes to the optimisation of a national acute stroke patient transport strategy. Modelling patient transport for system-level planning is sensitive to treatment times at both thrombolysis and thrombectomy centres and has important implications for the future planning of thrombectomy services.
Collections Ireland -> Dublin City University -> PubMed

Full list of authors on original publication

David Williams, Michael D Hill, Joseph Harbison, Paul Marsden, Joan McCormack, Gerald Wyse, Seamus Looby, Barry Moynihan, Dominick JH McCabe, Alan O'Hare and 12 others

Experts in our system

1
David Williams
Royal College of Surgeons in Ireland
Total Publications: 96
 
2
Joseph A Harbison
Trinity College Dublin
Total Publications: 27
 
3
Gerald Wyse
University College Cork
 
4
Seamus Looby
Royal College of Surgeons in Ireland
 
5
Dominick J H McCabe
Trinity College Dublin
Total Publications: 43