Mapping access to endovascular stroke care in the USA and implications for transport models

Abstract

BackgroundThe purpose of this cross-sectional study was to determine the percentage of the US population with 60 min ground or air access to accredited or state-designated endovascular-capable stroke centers (ECCs) and non-endovascular capable stroke centers (NECCs) and the percentage of NECCs with an ECC within a 30 min drive.MethodsStroke centers were identified and classified broadly as ECCs or NECCs. Geographic mapping of stroke centers was performed. The population was divided into census blocks, and their centroids were calculated. Fastest air and ground travel times from centroid to nearest ECC and NECC were estimated.ResultsOverall, 49.6% of US residents had 60 min ground access to ECCs. Approximately 37.7% (113 million) lack 60 min ground or air access to ECCs. Approximately 84.4% have 60 min access to NECCs. Ground-only access was available to 77.9%. Approximately 738 NECCs (45.4%) had an ECC within a 30 min drive.ConclusionNearly one-third of the US population lacks 60 min access to endovascular stroke care, but this is highly variable. Transport models and planning of additional centers should be tailored to each state depending on location and proximity of existing facilities.

Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study

“…A comprehensive geomapping analysis of current access in terms of travel times to MT centers could help policymakers improve LMIC stroke regionalization and expand the number of MT-capable centers adequately, as previously done in some HIC. [67][68][69][70] The creation of additional stroke centers should be undertaken in conjunction with stroke center certification or designation by national or international certifying bodies to ensure that the necessary quality metrics and quality monitoring processes are maintained. [71][72][73] For countries that lack a system of local or national MT center certification, collaboration with an international organization or a certifying body could facilitate this process.…”

Quantifying the amount of greater brain ischemia protection time with pre-hospital vs. in-hospital neuroprotective agent start

“…One is to initiate the NP agent at initial receiving hospitals that are non-thrombectomy centers so that it can act during the time needed for interfacility transfer to a thrombectomy-capable center. The challenge with this strategy is that fewer patients are now arriving at non-thrombectomy centers, due to the increased dissemination of thrombectomy-capable centers and the implementation by regional ambulance systems of direct routing to thrombectomy-capable centers of more severely injured patients ( 7 ). The remaining non-thrombectomy-capable centers are not only fewer than in the past, but also often do not have the research infrastructure to implement the initial trial enrollment and agent start.…”

Access to Mechanical Thrombectomy for Stroke: Center Qualifications, Prehospital Management, and Geographic Disparities

“…When considering 30-minute access, still only 95 million (30.9%) people had direct access. In a more recent study, Aldstadt et al 9 reported data from 1944 stroke centers based on the list of accreditations obtained from the Joint Commission. These included 322 (16.7%) TCCs and 1622 (83.7%) nonendovascular-capable centers (acute stroke-ready hospitals and PSCs).…”

“…The reduction of onsetto-puncture time is an extremely complex task, which faces obstacles not only within the micro aspects of health care facilities, such as patient transportation, triage, and in-hospital workflow, but also in the macro organization of stroke systems of care, geographic distribution of stroke centers, and socioeconomic and health care inequalities within the overall population. [8][9][10][11] We provide an overview of the current scenario of stroke care and discuss the main challenges in achieving effective, timely, and homogeneous MT availability to the overall US population.…”

“…5-7 Therefore, the concept of “time is brain” is the impetus driving the neurointerventional field toward reducing time from symptom onset to delivery of MT treatment, which we will refer to as “onset-to-puncture time.” The reduction of onset-to-puncture time is an extremely complex task, which faces obstacles not only within the micro aspects of health care facilities, such as patient transportation, triage, and in-hospital workflow, but also in the macro organization of stroke systems of care, geographic distribution of stroke centers, and socioeconomic and health care inequalities within the overall population. 8-11…”