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Published on: January 15, 2017
Regional Evaluation of the Severity-Based Stroke Triage Algorithm for Emergency Medical Services Using Discrete Event
Brittany M Bogle1, Andrew W Asimos2, Wayne D Rosamond2
1From the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (B.M.B., W.D.R.); and Department of Emergency Medicine, Carolinas Healthcare System, Charlotte, NC (A.W.A.). bbogle@email.unc.edu.
Optimizing stroke triage algorithms using simulation showed that undertriage was higher in King County, while overtriage varied by screen specificity. Simulation aids informed decisions for emergency medical services.
Area of Science:
- Emergency medicine
- Neurology
- Health services research
Background:
- The Severity-Based Stroke Triage Algorithm directs suspected large vessel occlusion acute ischemic stroke patients to endovascular stroke centers (ESCs).
- Evaluating regional algorithm variations is crucial for optimizing stroke care delivery.
Purpose of the Study:
- To assess the impact of different Severity-Based Stroke Triage Algorithm specifications on patient routing to ESCs.
- To compare algorithm performance metrics across different geographic regions.
Main Methods:
- A discrete event simulation environment was developed to model stroke patient transport.
- Simulations incorporated varying stroke severity screens and transport time parameters.
- Traffic-based travel times were used to estimate transport durations in King County, WA, and Mecklenburg County, NC.
Main Results:
- Undertriage rates were higher in King County compared to Mecklenburg County.
- Overtriage varied significantly based on the stroke severity screen used.
- Extended transport times (over 20 minutes) increased overtriage in King County but not Mecklenburg County.
- Lower specificity screens resulted in 3.7 times more patients routed to ESCs.
Conclusions:
- Discrete event simulation is a valuable tool for optimizing emergency medical services stroke triage algorithms.
- Simulation modeling can inform decision-making to improve the efficiency and effectiveness of stroke care routing.
- This study represents an initial step towards advanced simulation for predicting patient outcomes in stroke care.
