Saturday, March 28, 2015

Musing: Stroke Rounds: 'Golden Hour' Care Unlikely for One-Third of Americans

Dean Reinke
Deans’ Stroke Musing
Thursday, March 5, 2015

And because the stroke medical world has put all their eggs in the tPA basket strokies are f*cking screwed. tPA gets to maybe 10% of the people that are eligible for it at stroke centers and of those that get it it fully works to reverse the stroke only 12% of the time.  That scenario is one of the many reasons why the complete stroke medical world needs to be destroyed. This is why we need fast, objective diagnosis of strokes that don't require neurologists or scans or a stroke center for most patients.
Like this:
  1. New EEG electrode set for fast and easy measurement of brain function abnormalities
  2. Eye-Tracking Tool Might Quickly Spot Stroke
  3. How the wave of a wand can detect bleeding in the brain
  4. Neurokeeper EEG Headset Spots Signs of Stroke in Brainwave Signatures
  5. Pupil response via infrared light
  6. Brain oximeter and frontal near-infrared spectroscopy
  7. Ischiban headband
Maybe you want to look at these:

Stroke Rounds: 'Golden Hour' Care Unlikely for One-Third of Americans - Even under an optimistic scenario, as many as 114 million people in the U.S. would be unable to reach a comprehensive stroke center (CSC) using ground transportation within the critical treatment "golden hour," researchers estimated.

Using mathematical optimization modeling assuming the conversion of up to 20 optimally located primary stroke centers (PSCs) to CSCs per state, researcher Michael T. Mullen, MD, of the University of Pennsylvania, Philadelphia, and colleagues estimated that 63% of the population would live within a 1-hour drive and an additional 23% within a 1-hour flight of a stroke center.


Ground access would be lower in the southeastern U.S. "Stroke Belt" than in non-Stroke Belt states (32% versus 58.6%; P=0.02) and lower in states without emergency medical service routing policies (52.7% versus 68.3%; P=0.04), Mullen and colleagues wrote online in Neurology.

The modeling also suggested that in one-quarter of states, less than 60% of the population would have 60-minute air or ground access to a CSC.

"Because CSCs have not yet been proven to improve outcomes relative to other hospitals, the ideal level of population access is unknown," the researchers wrote. "Nonetheless, variability in access across states is important, because it suggests that there is a potential for significant geographic disparities in access to care."

Three-Tiered System for Stroke Treatment

In an effort to maximize early treatment of stroke patients, a three-tiered system based on the ability to care for increasingly complicated stroke patients has been proposed consisting of acute-stroke-ready hospitals, PSCs, and CSCs.

Certification of CSCs began in September of 2012, and as of May 2014 there were 70 certified CSCs operating in 25 states in the U.S., according to figures from the American Heart Association.

In their newly published study, Mullen and colleagues used mathematical modeling to estimate the optimal number and location of CSCs -- to which some PSCs could theoretically convert -- to maximize 1-hour access to care within the U.S.

"Up to 20 PSCs per state were selected for conversion to maximize the population with 60-minute access by ground and air," the researchers wrote. "Access was compared across states based on region and the presence of state-level emergency medical service policies preferentially routing patients to stroke centers."

There were 811 PSCs and no CSCs in the U.S. in 2010, according to figures from the Joint Commission, and two-thirds of Americans (65.8%) had 60-minute ground access to these centers, according to the researchers.

"After adding up to 20 optimally located CSCs per state, 63.1% of the U.S. population had 60-minute ground access and 86% had 60-minute ground/air access to a CSC," the researchers wrote.

See the original article:

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