TY - JOUR T1 - Redistributing medical resources for a bypass strategy for large vessel occlusion: a community-based study JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 98 LP - 103 DO - 10.1136/neurintsurg-2019-014851 VL - 12 IS - 1 AU - Ting-Yu Liu AU - Chun-Han Wang AU - Wen-Chu Chiang AU - Sung-Chun Tang AU - Li-Kai Tsai AU - Chung-Wei Lee AU - Jiann-Shing Jeng AU - Matthew Huei-Ming Ma AU - Ming-Ju Hsieh AU - Yu-Ching Lee Y1 - 2020/01/01 UR - http://jnis.bmj.com/content/12/1/98.abstract N2 - Background A bypass strategy for large vessel occlusion (LVO) benefits patients receiving endovascular thrombectomy (EVT), but may delay some patients from receiving IV thrombolysis. However, patient centralization has been shown to improve outcomes.Objective To understand the current coverage of medical services for patients with stroke, and to identify the best coverage under different medical resource redistribution to help balance medical equality and patient centralization.Methods This 6-year geographic study of 7679 on-scene patients with suspected stroke with a positive Cincinnati Prehospital Stroke Scale (CPSS) score identified 4037 patients with all three CPSS items who were suspected as having an LVO. Geographic, population, and patient coverage rates for hospitals providing IV thrombolysis and those providing EVT were identified according to hospital service areas, defined as geographic districts with access to a hospital within a ≤15 min off-peak driving time estimated using Google Maps. Moreover, we estimated the effects on resource redistribution when implementing a bypass strategy.Results Geographic coverage rates for hospitals providing IV thrombolysis and those providing EVT were 64.75% and 56.62%, respectively, and population coverage rates were 97.30% and 92.72%, respectively. The service areas of hospitals providing IV thrombolysis covered 93.77% of patients with suspected stroke, and those of hospitals providing EVT covered 87.89% of patients with suspected LVO. The number of hospitals providing IV thrombolysis and those providing EVT could be reduced to six and two hospitals, respectively, without affecting hospital arrival time when implementing a bypass strategy.Conclusion Hospitals providing IV thrombolysis and EVT could be reduced without reducing medical equality. ER -