ArticleJournal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia2019
Emergency medical services for acute ischemic stroke: Hub-and-spoke model versus exclusive care in comprehensive centers.
Article in Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 13 citations in OpenAlex.
- Incidence of mechanical thrombectomy among stroke patients brought directly to a comprehensive stroke center versus transfer from a primary stroke center in upstate New York.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025Article
- Time to Transfer as a Quality Improvement Imperative: Implications of a Hub-and-Spoke Health System Model on the Timing of Emergency Procedures.Joint Commission journal on quality and patient safety · 2023Article
- Delivering acute stroke care in a middle-income country. The Mexican model: "ResISSSTE Cerebro".Frontiers in neurology · 2023Article
- Article
- Effect of standardized nursing cooperation on intravenous thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke.American journal of translational research · 2021Article
- Effect of lockdown on the management of ischemic stroke: an Italian experience from a COVID hospital.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2020Observational
- Assessment of Stroke Case-fatality, Disability, Perceived Needs and Barriers for Care among First-ever Stroke Patients Attending a Tertiary Care Neuro-specialty Center in India: A Cross-sectional Study.Indian journal of community medicine : official publication of Indian Association of Preventive & Social MedicineArticle
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Authors and funding
5 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundThe emergent disposition of acute stroke patients remains an issue of debate. We investigated whether a hub-and-spoke model was associated with worse stroke outcomes when compared to care exclusively in comprehensive centers.
methodsWe performed a cohort study of all acute ischemic stroke patients who were hospitalized in endovascular-capable facilities, and were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2009 to 2015. We examined the association of transfer status (transfer to endovascular capable hospitals versus initial treatment in these facilities) with inpatient case-fatality, discharge to a facility, and length of stay (LOS). An instrumental variable analysis was used to control for unmeasured confounding and simulate a randomized trial.
resultsDuring the study period, 128,122 acute stroke patients met inclusion criteria. Instrumental variable analysis demonstrated that patients transferred to endovascular-capable hospitals did not have higher case-fatality (Adjusted difference, 4.4%; 95% CI, -0.1% to 9.0%), rate discharge to a facility (Adjusted difference, -2.3%; 95% CI, -5.2% to 0.6%), or longer LOS (Adjusted difference, 4.2; 95% CI, -2.2 to 10.1) in comparison to patients presenting for initial treatment in these facilities. The same associations were present when restricting the cohort to patients receiving intravenous tissue plasminogen (IV-tPA) and to patients receiving mechanical thrombectomy.
conclusionsUsing a comprehensive all-payer cohort of acute ischemic stroke patients in New York State we demonstrated that patients treated in a hub-and-spoke model were not associated with worse outcomes than patients receiving care exclusively in comprehensive institutions. This needs to be taken into consideration when considering acute emergency services in this setting.
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