Background

Triage for suspected acute stroke has two main options (1) transport to the closest primary stroke center (PSC) and then to the nearest comprehensive stroke center (CSC) (Drip-and-Ship) or (2) transport the patient to the nearest CSC, bypassing a closer PSC (mothership). The purpose was to evaluate the effectiveness of drip-and-ship versus mothership models for acute stroke patients.

Methods

A Markov decision-analytic model was constructed. All model parameters were derived from recent medical literature. Our target population is adult patient with sudden onset of acute stroke over a one-year horizon. The primary outcome is quantified in term of quality-adjusted-life-years (QALYs).

Results

The base-case scenario shows the Drip-and-Ship strategy has a slightly higher expected health benefit, 0.591 QALY, as compared to 0.586 QALY in the Mothership strategy when the time to PSC is 30 minutes and to CSC is 65 minutes, although the difference in health benefit becomes minimal as the time to PSC increases towards 60 min.

Multiple sensitivity analyses show that when both PSC and CSC are far from place of onset (>1.5 hours away), Drip-and-Ship becomes the better strategy. Mothership strategy is favored by smaller difference between distances to PSC and CSC, shorter transfer time from PSC to CSC, and longer delay in reperfusion in CSC for transferred patients. Drip-and-Ship is favored by the reverse.

Conclusion

Drip-and-ship has a slightly higher utility than mothership. This study assesses the complex issue of prehospital triage of acute stroke patients, and can provide a framework for real-world data input.

背景

疑似急性卒中的分诊有两个主要选择（1）转运到最近的初级卒中中心（PSC），然后转运到最近的综合卒中中心（CSC）（Drip-and-Ship）或（2）将患者转运到最近的卒中中心CSC，绕过更接近的 PSC（母舰）。目的是评估滴灌式与母式模型对急性卒中患者的有效性。

方法

构建了马尔可夫决策分析模型。所有模型参数均来自最近的医学文献。我们的目标人群是在一年内突发急性卒中的成年患者。主要结果以质量调整生命年 (QALYs) 进行量化。

结果

基本情况情景显示，Drip-and-Ship 策略的预期健康收益略高，为 0.591 QALY，而在 PSC 为 30 分钟和 CSC 为 65 分钟时，母舰策略为 0.586 QALY，尽管随着 PSC 时间接近 60 分钟，健康益处的差异变得最小。

多重敏感性分析表明，当 PSC 和 CSC 都远离发病地点（>1.5 小时）时，Drip-and-Ship 成为更好的策略。母系策略受 PSC 和 CSC 距离差异较小、从 PSC 到 CSC 的转移时间更短以及转移患者在 CSC 再灌注延迟更长的青睐。Drip-and-Ship 则相反。

结论

Drip-and-ship 的效用比 Mothership 略高。本研究评估了急性卒中患者院前分诊的复杂问题，并可以为现实世界的数据输入提供框架。