The MAPSTROKE project: A computational strategy to improve access to acute stroke care.

Autor:	Carbonera LA; Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil., Rivillas JA; Department of Neurology, Fundación Valle del Lili Hospital Universitario, Cali, Colombia.; Public Health Department, Universidad Icesi, Cali, Colombia., Gordon Perue G; Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA., da Luz Dorneles L; Institute of Informatics and Center for Biotechnology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil., Boiani M; Institute of Informatics and Center for Biotechnology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil., de Souza AC; Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil., Sampaio Silva G; Department of Neurology, Universidade Federal de São Paulo (UNIFESP) and Hospital Israelita Albert Einstein, São Paulo, Brazil., Dorn M; Institute of Informatics and Center for Biotechnology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil., Martins SCO; Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil.; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
Jazyk:	angličtina
Zdroj:	International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2024 Aug; Vol. 19 (7), pp. 747-753. Date of Electronic Publication: 2024 Feb 28.
DOI:	10.1177/17474930241234528
Abstrakt:	Background: Global access to acute stroke treatment is variable worldwide, with notable gaps in low and middle-income countries (LMIC), especially in rural areas. Ensuring a standardized method for pinpointing the existing regional coverage and proposing potential sites for new stroke centers is essential to change this scenario. Aims: To create and apply computational strategies (CSs) to determine optimal locations for new acute stroke centers (ASCs), with a pilot application in nine Latin American regions/countries. Methods: Hospitals treating acute ischemic stroke (AIS) with intravenous thrombolysis (IVT) and meeting the minimum infrastructure requirements per structured protocols were categorized as ASCs. Hospitals with emergency departments, noncontrast computed tomography (NCCT) scanners, and 24/7 laboratories were identified as potential acute stroke centers (PASCs). Hospital geolocation data were collected and mapped using the OpenStreetMap data set. A 45-min drive radius was considered the ideal coverage area for each hospital based on the drive speeds from the OpenRouteService database. Population data, including demographic density, were obtained from the Kontur Population data sets. The proposed CS assessed the population covered by ASCs and proposed new ASCs or artificial points (APs) settled in densely populated areas to achieve a target population coverage (TPC) of 95%. Results: The observed coverage in the region presented significant disparities, ranging from 0% in the Bahamas to 73.92% in Trinidad and Tobago. No country/region reached the 95% TPC using only its current ASCs or PASCs, leading to the proposal of APs. For example, in Rio Grande do Sul, Brazil, the introduction of 132 new centers was suggested. Furthermore, it was observed that most ASCs were in major urban hubs or university hospitals, leaving rural areas largely underserved. Conclusions: The MAPSTROKE project has the potential to provide a systematic approach to identify areas with limited access to stroke centers and propose solutions for increasing access to AIS treatment. Data Access Statement: Data used for this publication are available from the authors upon reasonable request. Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LAC reports receiving a restricted grant from the World Stroke Organization and the Angels Initiative/Boehringer Ingelheim for this work and consulting and speaker fees from Allm, AstraZeneca, Boehringer Ingelheim, and ISchemaView, outside of this work. JAR has received funding from Boehringer Ingelheim outside of this work. GGP receives research salary support from the FSR COHAN-A1 R2 contract for work done outside of this work. LLD receives a scholarship from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)—Brazil outside of this work. MB receives a scholarship from the CAPES—Brazil outside of this work. ACS received a restricted grant from Boehringer Ingelheim outside of this work. GSS reports funding from the Brazilian Ministry of Health for the Resilient and OPTIMAL trials; consulting and speaker fees from AstraZeneca, Biogen, Boehringer Ingelheim, and Pfizer; and speaker fees from Abbott, outside of this work. MD received grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (408154/2022-5; 314082/2021-2; 440279/2022-4); CAPES (STICAMSUD 88881.522073/2020-01), outside of this work. SCOM reports funding from the Brazilian Ministry of Health for the Resilient and PROMOTE trials and speaker fees from Boehringer Ingelheim, Pfizer, Bayer, Medtronic, Penumbra, Novartis, Novo Nordisk, Servier, Daiichi Sankyo, and Astra Zeneca.
Databáze:	MEDLINE
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