Determining the Need for Thrombectomy-Capable Stroke Centers Based on Travel Time to the Nearest Comprehensive Stroke Center

Abstract

Background: In January 2018 The Joint Commission introduced its Thrombectomy-Capable Stroke Center (TSC) certification program to recognize hospitals capable of performing endovascular thrombectomy for patients with ischemic strokes due to large vessel occlusions, intended for hospitals not in close geographic proximity to Comprehensive Stroke Centers (CSCs). This study was conducted to determine (1) the travel times between current and potential TSCs and the nearest CSC and (2) the proportion of TSCs that were in areas of high need.

Methods: The locations of current and applicant TSCs (N = 44) were mapped and paired with the closest CSCs. Google Maps estimated travel times for each pair at 8:00 a.m., 12:00 a.m., and 5:00 p.m. on Wednesdays, providing the minimum, maximum, and midpoint for each period. The area served by each TSC was classified based on the number of time periods with drive times > 30 or > 60 minutes to the closest CSC ("very low need" [0 of 3], "low need" [1 of 3], "high need" [2 of 3], or "very high need" [3 of 3]).

Results: Using minimum drive times and the > 30 minute to the nearest CSC threshold, 68.2% of the 44 TSCs were in very low need areas, and 29.5% were in very high need areas. Using maximum drive times, 31.8% were in high need areas, and 31.8% were in very high need areas. With a 60-minute threshold, 25.0% were still in very high need areas.

Conclusion: Many TSCs were in very low need areas using a 30-minute threshold. This methodology may help regional authorities determine how a TSC should be included in stroke systems of care prehospital destination protocols.