Evaluating potential spatial access to trauma center care by severely injured patients

Lawson, Fiona; Schuurman, Nadine; Oliver, Lisa; Nathens, Avery B.

doi:10.1016/j.healthplace.2012.10.011

Cited by 27 publications

(23 citation statements)

References 46 publications

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Section: Discussionmentioning

confidence: 99%

“…Patterns of access limitation similar to those observed in the current study have been seen in care for acute coronary syndromes and trauma care. 16 The ESCAPE trial delivered rapid endovascular treatment to patients who had had a stroke and had proximal intracranial occlusion on imaging at 11 sites in Canada, improving clinical outcomes and reducing mortality.14 The key difference between the trial sites and the current analysis is that the proposed sites cover the large population centres of Vancouver and Winnipeg. One pan-Canadian study similarly used geospatial tools to estimate the proportion of the population with 60-, 90-and 120-minute access to a hospital with the minimum requirements to treat stroke (a third-or fourth-generation computed tomography scanner, a neurologist and an emergency physician on staff).…”

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confidence: 99%

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Access to hyperacute stroke services across Canadian provinces: a geospatial analysis

et al. 2017

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Background: Canada's vast geography creates challenges for ensuring prompt transport to hospital of patients who have had a stroke. We sought to determine the proportion of people across various Canadian provinces for whom hyperacute stroke services are accessible within evidence-based time targets. Methods:We calculated, for the 8 provinces with available data, drive-time polygons on a map of Canada that delineated the area around stroke centres and emergency medical services (EMS) base centres to which one can drive in 3.5-6 hours. We calculated the proportional area of each forward sortation area (first 3 digits of the postal code) contained within a drive-time polygon. We applied this ratio to the 2011 Canadian census population of the forward sortation area to estimate the population that can reach a stroke centre in a designated time.Results: A total of 47.1%-96.4% of Canadians live within a 4.5-hour drive to a stroke centre via road EMS, and 53.3%-96.8% live within a 6-hour drive. Assuming a total travel time of 5 hours by EMS from base centre to patient and patient to hospital, 84.7%-99.8% of the population has access to a current or proposed endovascular thrombectomy site. Interpretation:Most Canadians live within 6 hours' road access to a stroke centre. Geospatial mapping could be used to inform decisions for additional sites and identify gaps in service accessibility. Coordinated systems of care and ambulance bypass agreements must continue to evolve to ensure maximal access to time-sensitive emergency stroke services. AbstractResearch Research CMAJ OPENCMAJ OPEN, 5(2) E455 lations may not be able to benefit from either alteplase or endovascular thrombectomy. Canada's vast geography creates challenges for ensuring prompt transport to hospital. To inform ongoing efforts to plan and improve the health care system with the goal of optimizing delivery of stroke services, we sought to determine the proportion of people across several provinces for whom hyperacute stroke services are currently accessible via EMS. MethodsWe estimated the population with access to stroke centres in sufficient time for treatment, by province, using the 2011 Canadian population census. We compared the area within which residents could be reached by an ambulance (travelling by road) and then driven to a stroke hospital to the population in those regions (based on forward sortation area [first 3 digits of postal code]) to determine the proportion of residents who could reach a hospital 3.5-6 hours after contacting EMS or by driving themselves to hospital (Figure 1). Postal codes in Canada are assigned based on a combination of geography, population and city planning. Generally speaking, more densely populated areas have smaller postal code geographic areas than do more sparsely populated areas.We used geospatial analyses with geographic information systems technology [11][12][13] to generate drive-time polygons. A drive-time polygon represents a shape on a map that contains all points a driver can theoretically reach from a s...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Access to hyperacute stroke services across Canadian provinces: a geospatial analysis

et al. 2017

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“…In Canada, injuries are the leading cause of death during the first four decades of life [2]. Half of the deaths due to injuries occur at the site of the incident and it is estimated that the remaining 50% could be avoided if they had access to appropriate medical care [3]. Major injuries should be treated in a designated trauma centre (TC), certified by competent health authorities [3].…”

Section: Introductionmentioning

confidence: 99%

“…Half of the deaths due to injuries occur at the site of the incident and it is estimated that the remaining 50% could be avoided if they had access to appropriate medical care [3]. Major injuries should be treated in a designated trauma centre (TC), certified by competent health authorities [3]. These TCs are acute care facilities which have a trauma team immediately available to assess patients and dispose of all the resources needed to provide appropriate and definitive care to these patients [2].…”

Section: Introductionmentioning

confidence: 99%

Access to a Canadian provincial integrated trauma system: A population-based cohort study

Batomen

Moore

Cissé

et al. 2015

Injury

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“…A common assumption for all of these studies is that the location of residence serves as an adequate proxy for the location of traumatic events . Based on this assumption, the access of a traumatic injury to trauma centers can therefore be approximated by the proximity of a patient residence to trauma centers.…”

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confidence: 99%

Injury‐based Geographic Access to Trauma Centers

Wei

Mann

Dai

et al. 2018

Academic Emergency Medicine

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Evaluating potential spatial access to trauma center care by severely injured patients

Cited by 27 publications

References 46 publications

Access to hyperacute stroke services across Canadian provinces: a geospatial analysis

Access to hyperacute stroke services across Canadian provinces: a geospatial analysis

Access to a Canadian provincial integrated trauma system: A population-based cohort study

Injury‐based Geographic Access to Trauma Centers

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