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Background The RACECAT (Transfer to the Closest Local Stroke Center vs Direct Transfer to Endovascular Stroke Center of Acute Stroke Patients With Suspected Large Vessel Occlusion in the Catalan Territory) trial was the first randomized trial addressing the prehospital triage of acute stroke patients based on the distribution of thrombolysis centers and intervention centers in Catalonia, Spain. The study compared the drip-and-ship with the mothership paradigm in regions where a local thrombolysis center can be reached faster than the nearest intervention center (equipoise region). The present study aims to determine the population-based applicability of the results of the RACECAT study to 4 stroke networks with a different degree of clustering of the intervention centers (clustered, dispersed). Methods and Results Stroke networks were compared with regard to transport time saved for thrombolysis (under the drip-and-ship approach) and transport time saved for endovascular therapy (under the mothership approach). Population-based transport times were modeled with a local instance of an openrouteservice server using open data from OpenStreetMap.The fraction of the population in the equipoise region differed substantially between clustered networks (Catalonia, 63.4%; France North, 87.7%) and dispersed networks (Southwest Bavaria, 40.1%; Switzerland, 40.0%). Transport time savings for thrombolysis under the drip-and-ship approach were more marked in clustered networks (Catalonia, 29 minutes; France North, 27 minutes) than in dispersed networks (Southwest Bavaria and Switzerland, both 18 minutes). Conclusions Infrastructure differences between stroke networks may hamper the applicability of the results of the RACECAT study to other stroke networks with a different distribution of intervention centers. Stroke networks should assess the population densities and hospital type/distribution in the temporal domain before applying prehospital triage algorithms to their specific setting.

背景

RACECAT（转移至距离最近的当地卒中中心与直接转移至血管内卒中中心治疗疑似大血管闭塞的急性卒中患者）试验是第一项基于西班牙加泰罗尼亚溶栓中心和介入中心分布情况，对急性卒中患者进行院前分诊的随机试验。该研究比较了在当地溶栓中心能够更快到达的区域中采用滴注-转院与母舰模式的差异（均衡区域）。本研究旨在确定 4 个卒中网络的结果在多大程度上适用于 RACECAT 研究，这 4 个卒中网络的介入中心分布具有不同程度的聚集性（聚集性、分散性）。

方法和结果

卒中网络在溶栓时节省的转运时间（采用滴注-转院方法）和血管内治疗时节省的转运时间（采用母舰方法）方面进行了比较。使用开放街道地图的开放数据，通过本地实例的 openrouteservice 服务器对基于人群的转运时间进行建模。均衡区域的人口比例在聚集性网络（加泰罗尼亚，63.4%；法国北部，87.7%）和分散性网络（巴伐利亚西南部，40.1%；瑞士，40.0%）之间存在显著差异。采用滴注-转院方法，溶栓时的转运时间节省在聚集性网络（加泰罗尼亚，29 分钟；法国北部，27 分钟）中比分散性网络（巴伐利亚西南部和瑞士，均为 18 分钟）更为显著。