Drip and Ship versus Mothership: Transportation and Treatment Strategies for Acute Ischemic Stroke Patients

Holodinsky, Jessalyn Kathryn

Drip and Ship versus Mothership: Transportation and Treatment Strategies for Acute Ischemic Stroke Patients

dc.contributor.advisor	Hill, Michael D.
dc.contributor.author	Holodinsky, Jessalyn Kathryn
dc.contributor.committeemember	Williamson, Tyler S.
dc.contributor.committeemember	Demchuk, Andrew M.
dc.contributor.committeemember	Patel, Alka B.
dc.date	2019-11
dc.date.accessioned	2019-07-22T20:34:52Z
dc.date.available	2019-07-22T20:34:52Z
dc.date.issued	2019-07-22
dc.description.abstract	Ischemic stroke with large vessel occlusion can be treated with alteplase and/or endovascular therapy. While endovascular therapy has been proven more effective than alteplase the administration of both treatments is highly time sensitive. There are geographic disparities in access to endovascular therapy. For patients outside the immediate vicinity of a hospital equipped to perform endovascular therapy it is unknown whether transport directly to an endovascular center for alteplase and endovascular therapy (mothership) or transport to the closest centre for immediate alteplase treatment followed by transfer to the endovascular center (drip-and-ship) will result in best patient outcomes. In this thesis, this is explored using theoretical conditional probability. Models were generated using existing data from clinical trials of stroke treatment, the accuracy of prehospital large vessel occlusion screening tools, and time from onset to stroke treatment (a function of both geography and hospital efficiency). The models were used to determine which strategy predicts the greatest probability of excellent outcome for stroke patients in several different scenarios. The optimal transport strategy is influenced by three different factors, the impact of which is summarized as follows from the perspective of the drip and ship approach. First, the most probable diagnosis of the patient. As the positive predictive value of the large vessel occlusion screening tool decreases the importance of the drip and ship model is appreciated. Second, the speed of treatment at the receiving hospitals. Fast treatment at thrombolysis centres is key for the drip and ship model to remain viable. Finally, the patient’s travel time to and between the different hospitals. As the distance between the thrombolysis and endovascular centre increases again the importance of the drip and ship model is realized. This thesis presents a novel way of conceptualizing the pre-hospital transport of suspected stroke patients. Decision-making for pre-hospital transport can be modelled using existing clinical trial data; these models can be dynamically adapted to changing realities. As the radius of superiority of the different transport strategy is context specific regional customization transport protocols for stroke patients is essential.	en_US
dc.identifier.citation	Holodinsky, J. K. (2019). Drip and Ship versus Mothership: Transportation and Treatment Strategies for Acute Ischemic Stroke Patients (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.	en_US
dc.identifier.doi	http://dx.doi.org/10.11575/PRISM/36758
dc.identifier.uri	http://hdl.handle.net/1880/110657
dc.language.iso	eng	en_US
dc.publisher.faculty	Cumming School of Medicine	en_US
dc.publisher.institution	University of Calgary	en
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.	en_US
dc.subject.classification	Epidemiology	en_US
dc.title	Drip and Ship versus Mothership: Transportation and Treatment Strategies for Acute Ischemic Stroke Patients	en_US
dc.type	doctoral thesis	en_US
thesis.degree.discipline	Medicine – Community Health Sciences	en_US
thesis.degree.grantor	University of Calgary	en_US
thesis.degree.name	Doctor of Philosophy (PhD)	en_US
ucalgary.item.requestcopy	true	en_US