The MAPSTROKE project: a Computational Strategy to Improve Access to Acute Stroke Care.

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 (CS) 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, non-contrast CT scanners, and 24/7 laboratories were identified as Potential Acute Stroke Centers (PASCs). Hospital geolocation data were collected and mapped using the OpenStreetMap® dataset. A 45-minute 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, was obtained from the Kontur Population® datasets. 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.