Key result
Mothership model predicts ~8% more disability-free stroke outcomes vs drip-and-ship but causes unsustainable center admissions.
Why the study?
To guide policy when planning reperfusion IVT and MT services for acute stroke in England, focusing on the choice between mothership and drip-and-ship provision and the impact of bypassing local acute stroke centres.
Does the 'mothership' model improve disability-free outcomes compared to the 'drip-and-ship' model in acute stroke patients?
Does the 'mothership' model improve disability-free outcomes compared to the 'drip-and-ship' model in acute stroke patients?
Effect estimate: 2.4 additional disability-free outcomes per 1,000 admissions
Absolute Event Rate: 33.5% vs 31.1%
While a mothership model for acute stroke reperfusion improves clinical outcomes, a hybrid approach with drip-and-ship is required to maintain sustainable admission numbers across stroke centers.
Mothership maximizes modeled benefit for most patients but risks destabilizing admission volumes; leaves open optimal hybrid configurations for sustainable English stroke services.
Objectives: To guide policy when planning reperfusion thrombolysis (IVT) and thrombectomy (MT) services for acute stroke in England, focussing on the choice between ‘mothership’ (direct conveyance to an MT centre) and ‘drip-and-ship' (secondary transfer for MT after local IVT) provision and the impact of bypassing local acute stroke centres.Methods: Computer modelling was used to estimate the likely outcomes from reperfusion therapies, along with admission numbers to units, based on expected times to IVT and MT.Results: Without pre-hospital selection for LAO, 94% of the population of England live in areas where the greatest clinical benefit accrues from direct conveyance to an IVT/MT centre. If this model was followed then net benefit from reperfusion is predicted to be increased from 31 to 34 additional disability-free outcomes / 1,000 admissions. However, this policy produces unsustainable admission numbers at these centres, and depletes all but 19 IVT-only units of all stroke admissions. Implementing a maximum permitted additional travel time to bypass an IVT-only unit, or using a pre-hospital test for LAO, both increase net benefit over the current drip-and-ship model, but produce a similar destabilising effect on acute systems of care. Use of IVT-only units manage admission numbers to IVT/MT centres.Conclusions: The mothership model reduces time to MT at the cost of increased time to IVT, but the benefit of faster MT is predicted to lead to a modest improvement in overall outcomes. Providing a sustainable national system of acute stroke care requires a hybrid of mothership and drip-and-ship provision.
No takes yet. Share an insight, caveat, or question.
Allen et al. (2021) studied Acute stroke (n=242,874). Mothership model (direct conveyance to MT centre) vs. Drip-and-ship model (local IVT then transfer for MT) was evaluated on Additional disability-free outcomes (mRS 0-1) per 1,000 admissions at 3 months (2.4 additional disability-free outcomes per 1,000 admissions). The mothership model for acute stroke is predicted to increase disability-free outcomes to 33.5 per 1,000 admissions compared to 31.1 for drip-and-ship, but causes unsustainable center admissions.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: