Dataset Information

Risk and space: modelling the accessibility of stroke centers using day- & nighttime population distribution and different transportation scenarios.

ABSTRACT:

Purpose

Rapid accessibility of (intensive) medical care can make the difference between life and death. Initial care in case of strokes is highly dependent on the location of the patient and the traffic situation for supply vehicles. In this methodologically oriented paper we want to determine the inequivalence of the risks in this respect.

Methods

Using GIS we calculate the driving time between Stroke Units in the district of Münster, Germany for the population distribution at day- & nighttime. Eight different speed scenarios are considered. In order to gain the highest possible spatial resolution, we disaggregate reported population counts from administrative units with respect to a variety of factors onto building level.

Results

The overall accessibility of urban areas is better than in less urban districts using the base scenario. In that scenario 6.5% of the population at daytime and 6.8% at nighttime cannot be reached within a 30-min limit for the first care. Assuming a worse traffic situation, which is realistic at daytime, 18.1% of the population fail the proposed limit.

Conclusions

In general, we reveal inequivalence of the risks in case of a stroke depending on locations and times of the day. The ability to drive at high average speeds is a crucial factor in emergency care. Further important factors are the different population distribution at day and night and the locations of health care facilities. With the increasing centralization of hospital locations, rural residents in particular will face a worse accessibility situation.

SUBMITTER: Rauch S

PROVIDER: S-EPMC8243862 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:Simple Summary Studying species distribution modelling in the face of climate change provides more insight into how endangered species are affected by these changes. Therefore, we studied two locally endangered owl species, the Boreal and Eurasian Pygmy Owl, in the Balkan Peninsula to better understand their current and future distribution. We aimed to perform species distribution modelling for these two targeted owl species in current climate and future predicted climate scenarios. We quantified highly suitable areas for both species currently and in future climate scenarios. Additionally, we looked at the size of the areas of future species’ refugia where environmental factors might be suitable for the species. Results showed that the future highly suitable area for Boreal Owl shrunk compared to the current area in all climate scenarios; however, for Eurasian Pygmy Owl, the results did not follow such a clear trend. Our study is important from the species’ conservation perspective and fills a knowledge gap about species distribution in the Balkan Peninsula. Abstract Studying current and future geographic distribution is essential for conserving endangered species such as the Boreal Owl and Eurasian Pygmy Owl. The main aim of this study was to determine the potential distribution of both species in the Balkan Peninsula by using spatial distribution models (SDMs) in MaxEnt. We used data from field surveys, the scientific and grey literature, and an online database. We considered the current time and two future periods, 2041–2060 and 2061–2080. For future periods, we included different climate scenarios (SSP 126, 245, 370, and 585) in studying the potential geographic distribution of both species. We identified two types of potential future refugia for species: in situ and ex situ. Our study shows the highly suitable area for the Boreal Owl increased during the 2041–2060 period compared with the current area in all scenarios, except in SSP 585. However, during the 2061–2080 period, the highly suitable areas contracted. For the Eurasian Pygmy Owl, highly suitable areas decreased during 2041–2060, but during the 2061–2080 period, it was larger than the current area. Our study is of importance for conservation and preserving areas of potential distribution and refugia for Boreal and Eurasian Pygmy Owls in the face of climate change.

Project description:BackgroundTo improve stroke care, the Brain Attack Coalition recommended establishing primary stroke center (PSC) and comprehensive stroke center (CSC) certification. This study aimed to compare ischemic stroke care and in-hospital outcomes between CSCs and PSCs.Methods and resultsWe analyzed patients with acute ischemic stroke who were hospitalized at stroke centers participating in Get With The Guidelines-Stroke from 2013 to 2015. Multivariable logistic regression models were generated to examine the association between stroke center certification (CSC versus PSC) and performances and outcomes. This study included 722 941 patients who were admitted to 134 CSCs and 1047 PSCs. Both CSCs and PSCs had good conformity to 7 performance measures and the summary defect-free care measure. Among emergency department admissions, CSCs had higher intravenous tPA (tissue-type plasminogen activator) and endovascular thrombectomy rates than PSCs (14.3% versus 10.3%, 4.1% versus 1.0%, respectively). Door to intravenous tPA time was shorter at CSCs (median, 52 versus 61 minutes; adjusted risk ratio, 0.92; 95% confidence interval, 0.89-0.95). More patients at CSCs had door to intravenous tPA time ≤60 minutes (79.7% versus 65.1%; adjusted odds ratio, 1.48; 95% confidence interval, 1.25-1.75). For transferred patients, CSCs and PSCs had comparable overall performance in defect-free care, except higher endovascular thrombectomy therapy rates. The overall in-hospital mortality was higher at CSCs in both emergency department admissions (4.6% versus 3.8%; adjusted odds ratio, 1.14; 95% confidence interval, 1.01-1.29) and transferred patients (7.7% versus 6.8%; adjusted odds ratio, 1.17; 95% confidence interval, 1.05-1.32). In-hospital outcomes were comparable between CSCs and PSCs in patients who received intravenous tPA or endovascular thrombectomy.ConclusionsCSCs and PSCs achieved similar overall care quality for patients with acute ischemic stroke. CSCs exceeded PSCs in timely acute reperfusion therapy for emergency department admissions, whereas PSCs had lower risk-adjusted in-hospital mortality. This information may be important for acute stroke triage and targeted quality improvement.

Project description:BackgroundPrehospital triage protocols typically try to select patients with Injury Severity Score (ISS) above 15 for direct transportation to a Level-1 trauma center. However, ISS does not necessarily discriminate between patients who benefit from immediate care at Level-1 trauma centers. The aim of this study was to assess which patients benefit from direct transportation to Level-1 trauma centers.MethodsWe used the American National Trauma Data Bank (NTDB), a retrospective observational cohort. All adult patients (ISS > 3) between 2015 and 2016 were included. Patients who were self-presenting or had isolated limb injury were excluded. We used logistic regression to assess the association of direct transportation to Level-1 trauma centers with in-hospital mortality adjusted for clinically relevant confounders. We used this model to define benefit as predicted probability of mortality associated with transportation to a non-Level-1 trauma center minus predicted probability associated with transportation to a Level-1 trauma center. We used a threshold of 1% as absolute benefit. Potential interaction terms with transportation to Level-1 trauma centers were included in a penalized logistic regression model to study which patients benefit.ResultsWe included 388,845 trauma patients from 232 Level-1 centers and 429 Level-2/3 centers. A small beneficial effect was found for direct transportation to Level-1 trauma centers (adjusted Odds Ratio: 0.96, 95% Confidence Interval: 0.92-0.99) which disappeared when comparing Level-1 and 2 versus Level-3 trauma centers. In the risk approach, predicted benefit ranged between 0 and 1%. When allowing for interactions, 7% of the patients (n = 27,753) had more than 1% absolute benefit from direct transportation to Level-1 trauma centers. These patients had higher AIS Head and Thorax scores, lower GCS and lower SBP. A quarter of the patients with ISS > 15 were predicted to benefit from transportation to Level-1 centers (n = 26,522, 22%).ConclusionsBenefit of transportation to a Level-1 trauma centers is quite heterogeneous across patients and the difference between Level-1 and Level-2 trauma centers is small. In particular, patients with head injury and signs of shock may benefit from care in a Level-1 trauma center. Future prehospital triage models should incorporate more complete risk profiles.