ArticleEuropean stroke journal2022
National implementation of reperfusion for acute ischaemic stroke in England: How should services be configured? A modelling study.
Article in European stroke journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Diagnostic Accuracy of Lateral Flow Blood Tests to Detect Large Vessel Occlusion Stroke.Stroke (Hoboken, N.J.) · 2026Article
- Article
- Article
- Accessing mechanical thrombectomy treatment for stroke in England, Wales and Northern Ireland: the importance of the emergency pathway.Emergency medicine journal : EMJ · 2024Article
- Rapid Assay Diagnostic for Acute Stroke Recognition (RADAR): study protocol for a diagnostic accuracy study.BMJ open · 2024Observational
- Long Non-Coding H19 in Lymphocytes: Prognostic Value in Acute Ischemic Stroke Patients.Pharmaceuticals (Basel, Switzerland) · 2024Article
- Stroke survivor views on ambulance redirection as a strategy to increase access to thrombectomy in England.British paramedic journal · 2024Article
- The Capacitated Maximal Covering Location Problem Improves Access to Stroke Treatment: A Cross-Sectional Simulation Study.Health services insights · 2024Article
- Observational
- Prehospital stroke management and mobile stroke units.Current opinion in neurology · 2023Review
Corrections and comments
- Erratum issued
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Objectives: To guide policy when planning thrombolysis (IVT) and thrombectomy (MT) services for acute stroke in England, focussing on the choice between 'mothership' (direct conveyance to an MT centre) and 'drip-and-ship' (secondary transfer) provision and the impact of bypassing local acute stroke centres. Design: Outcome-based modelling study. Setting: 107 acute stroke centres in England, 24 of which provide IVT and MT (IVT/MT centres) and 83 provide only IVT (IVT-only units). Participants: 242,874 emergency admissions with acute stroke over 3 years (2015-2017). Intervention: Reperfusion delivered by drip-and-ship, mothership or 'hybrid' models; impact of additional travel time to directly access an IVT/MT centre by bypassing a more local IVT-only unit; effect of pre-hospital selection for large artery occlusion (LAO). Main outcome measures: Population benefit from reperfusion, time to IVT and MT, admission numbers to IVT-only units and IVT/MT centres. Results: Without pre-hospital selection for LAO, 94% of the population of England live in areas where the greatest clinical benefit, assuming unknown patient status, accrues from direct conveyance to an IVT/MT centre. However, this policy produces unsustainable admission numbers at these centres, with 78 out of 83 IVT-only units receiving fewer than 300 admissions per year (compared to 3 with drip-and-ship). Implementing a maximum permitted additional travel time to bypass an IVT-only unit, using a pre-hospital test for LAO, and selecting patients based on stroke onset time, all help to mitigate the destabilising effect but there is still some significant disruption to admission numbers, and improved selection of patients suitable for MT selectively reduces the number of patients who would receive IVT at IVT-only centres, challenging the sustainability of IVT expertise in IVT-only centres. Conclusions: Implementation of reperfusion for acute stroke based solely on achieving the maximum population benefit potentially leads to destabilisation of the emergency stroke care system. Careful planning is required to create a sustainable system, and modelling may be used to help planners maximise benefit from reperfusion while creating a sustainable emergency stroke care system.
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