2023 American Academy of Neurology Abstract Website

Kaylynn Purdy¹, Thomas Jeerakathil², Doug Owens³, Eran Bendavid³
¹Department of Health Policy, School of Medicine, Freeman-Spogli Institute for International Studies, Stanford University, and Department of Medicine, Division of Neurology, University of Alberta, ²Department of Medicine, Division of Neurology, University of Alberta, ³Department of Health Policy, School of Medicine, Freeman-Spogli Institute for International Studies, Stanford University

Objective:

To model the effectiveness of walk-in stroke centres (WSCs) in acute stroke care.

Background:

Access to thrombolytics for people experiencing acute stroke symptoms depends on the onset of symptoms to treatment time (OTT). Decreased OTT has mortality and disability benefits. Not all community hospitals offer thrombolytics for acute stroke symptoms, and patients must await transfer to a primary (PSC) or comprehensive stroke centre (CSC) before stroke therapy can be initiated. WSCs have been established in Northern Alberta enabling earlier access to thrombolytics for stroke patients who self-present. We assess the effectiveness based on the estimated time-saved in OTT of three WSCs on the outskirts of Edmonton, Alberta that are between 19-33 kilometers away from the local CSC.

Design/Methods:

The effectiveness of three WSCs was evaluated by estimating transportation times to thrombolysis in two counterfactual scenarios: with and without WSCs using >6000 postal-code origins. Stroke incidence was simulated using the age-stratified population distribution of Alberta using WorldPop data and Alberta vital statistics. Base-case mortality of thrombolysis treated strokes was obtained from the Quality Improvement and Clinical Research Alberta Stroke Program Database (QuICR). Effectiveness was measured as a function OTT difference based on transportation times in each scenario.

Results:

OTT can be decreased on average by 15.8, 19.5 and 21.5 minutes (range 0-30.9 min) for each WSC respectively. From this we estimated an average 1% potential reduction in stroke mortality and a 1% increase in the number of patients presenting within the 4.5hr thrombolytic window. Over 1-year WSCs could facilitate earlier treatment for 79.7% of strokes and when combined save 3.9/100,000 lives.

Conclusions:

Using population level data to simulate transport times for stroke patients we can model the efficacy of WSCs. With this method we found that WSCs can reduce mortality for acute stroke patients when a CSC or PSC is not a patient’s closest hospital.