Background Endovascular thrombectomy is not available at all hospitals that offer intravenous thrombolysis, prompting debate regarding the preferred transport destination for acute ischemic stroke. This study aimed to quantify real-world travel time and distance of bypass and non-bypass transport models for large-vessel occlusion (LVO) and non-LVO stroke.
Methods This cross-sectional study included population data of census tracts in the contiguous USA from the 2014–2018 United States Census Bureau’s American Community Survey, stroke (thrombolysis-capable) and thrombectomy-capable centers certified by a state or national body, and road network data from a mapping service. Census tracts were categorized by urbanization level. Data were retrieved from March to November 2020. Travel times and distances were calculated for each census tract to each of the following: nearest stroke center (nearest), nearest thrombectomy-capable center (bypass), and nearest stroke center then to the nearest thrombectomy-capable center (transfer). Population-weighted median and IQR were calculated nationally and by urbanization.
Results 72 538 census tracts, 2388 stroke hospitals, and 371 thrombectomy-capable centers were included. Nationally, population-weighted median travel time for nearest and bypass routing was 11.7 min (IQR 7.7–19.3) and 26.4 min (14.8–55.1), respectively. For transfer routing, the population-weighted median travel times with 60 min, 90 min, and 120 min door-in-door-out times were 94.1 min (78.5–127.7), 124.1 min (108.5–157.7), and 154.1 min (138.4–187.6), respectively.
Conclusions Bypass routing offers modest travel time benefits for LVO patients and incurs modest penalties for non-LVO patients. Differences are greatest in rural areas. A majority of Americans live in areas for which current guidelines recommend bypass.
Data availability statement
Data are available upon reasonable request.
Statistics from Altmetric.com
Contributors All authors meet ICMJE guidelines for authorship. CYY is responsible for the overall content as guarantor. CYY accepts full responsibility for the finished work and/or the conduct of the study, has full access to the data, and controlled the decision to publish. CYY made substantial contribution to the design of the work, acquisition and analysis of the data, drafting and revising critically for intellectual content, approved the final version, and agrees to be accountable. PDP made substantial contribution to the conception of the work, interpretation of the data, revising critically for intellectual content, approved the final version, and agrees to be accountable. APK made substantial contribution to the conception and design of the work, interpretation of the data, drafting and revising critically for intellectual content, approved the final version, and agrees to be accountable.
Funding This work was supported by the National Center for Advancing Translational Sciences under award number TL1TR002344.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.