ArticleEuropean stroke journal2019
Maximising access to thrombectomy services for stroke in England: A modelling study.
Article in European stroke journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed.
- Diagnostic Accuracy of Lateral Flow Blood Tests to Detect Large Vessel Occlusion Stroke.Stroke (Hoboken, N.J.) · 2026Article
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- Rapid Assay Diagnostic for Acute Stroke Recognition (RADAR): study protocol for a diagnostic accuracy study.BMJ open · 2024Observational
- Healthcare professional views about a prehospital redirection pathway for stroke thrombectomy: a multiphase deductive qualitative study.Emergency medicine journal : EMJ · 2024Article
- Stroke survivor views on ambulance redirection as a strategy to increase access to thrombectomy in England.British paramedic journal · 2024Article
- Professional and public views about early return of patients from Comprehensive Stroke Centers to local Acute Stroke Centers in England following displacement by emergency care pathways.Frontiers in stroke · 2024Article
- National implementation of reperfusion for acute ischaemic stroke in England: How should services be configured? A modelling study.European stroke journal · 2022Article
- Prediction modelling the impact of onset to treatment time on the modified Rankin Scale score at 90 days for patients with acute ischaemic stroke.BMJ neurology open · 2022Article
- Can Helicopters Solve the Transport Dilemma for Patients With Symptoms of Large-Vessel Occlusion Stroke in Intermediate Density Areas? A Simulation Model Based on Real Life Data.Frontiers in neurology · 2022Article
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- A Novel Combination of Blood Biomarkers and Clinical Stroke Scales Facilitates Detection of Large Vessel Occlusion Ischemic Strokes.Diagnostics (Basel, Switzerland) · 2021Article
- An update on hyper-acute management of ischaemic stroke.Clinical medicine (London, England) · 2021Review
- Secondary transfer of emergency stroke patients eligible for mechanical thrombectomy by air in rural England: economic evaluation and considerations.Emergency medicine journal : EMJ · 2021Article
- Regarding thrombectomy centre volumes and maximising access to thrombectomy services for stroke in England: A modelling study and mechanical thrombectomy for acute ischaemic stroke: An implementation guide for the UK.European stroke journal · 2020Article
- Letter to the Editor: Seeking clarification regarding caseload constraints in modelling of thrombectomy service delivery.European stroke journal · 2020Article
- Rationale and design for studying organisation of care for intra-arterial thrombectomy in the Netherlands: simulation modelling study.BMJ open · 2020Article
- Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation.BMC health services research · 2019Article
- What does it take to provide clinical interventions with temporal consistency? A qualitative study of London hyperacute stroke units.BMJ open · 2019Observational
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
purposeBoth intravenous thrombolysis (IVT) and intra-arterial endovascular thrombectomy (ET) improve the outcome of patients with acute ischaemic stroke, with endovascular thrombectomy being an option for those patients with large vessel occlusions. We sought to understand how organisation of services affects time to treatment for both intravenous thrombolysis and endovascular thrombectomy.
methodA multi-objective optimisation approach was used to explore the relationship between the number of intravenous thrombolysis and endovascular thrombectomy centres and times to treatment. The analysis is based on 238,887 emergency stroke admissions in England over 3 years (2013-2015).
resultsProviding hyper-acute care only in comprehensive stroke centres (CSC, providing both intravenous thrombolysis and endovascular thrombectomy, and performing >150 endovascular thrombectomy per year, maximum 40 centres) in England would lead to 15% of patients being more than 45 min away from care, and would create centres with up to 4300 stroke admissions/year. Mixing hyper-acute stroke units (providing intravenous thrombolysis only) with comprehensive stroke centres speeds time to intravenous thrombolysis and mitigates admission numbers to comprehensive stroke centres, but at the expense of increasing time to endovascular thrombectomy. With 24 comprehensive stroke centres and all remaining current acute stroke units as hyper-acute stroke units, redirecting patients directly to attend a comprehensive stroke centre by accepting a small delay (15-min maximum) in intravenous thrombolysis reduces time to endovascular thrombectomy: 25% of all patients would be redirected from hyper-acute stroke units to a comprehensive stroke centre, with an average delay in intravenous thrombolysis of 8 min, and an average improvement in time to endovascular thrombectomy of 80 min. The balance of comprehensive stroke centre:hyper-acute stroke unit admissions would change from 24:76 to 49:51.
conclusionPlanning of hyper-acute stroke services is best achieved when considering all forms of acute care and ambulance protocol together. Times to treatment need to be considered alongside manageable and sustainable admission numbers.
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