So you can quantify the bill you can provide your stroke hospital for not doing the absolute fastest puncture time. Door-to-needle is totally the wrong measurement. It should be how many minutes prior to door arrival. I had it in 90 minutes, so I lost 11,880 hours/495 days/1.34 years. Just maybe your stroke hospital/ambulance should be doing these much faster methods.
I was hoping one of these pieces of research would give me a value but they don't:
The value of DALY life: problems with ethics and validity of disability adjusted life years
Understanding and improving the one and three times GDP per capita cost-effectiveness thresholds
Economic Burden of Disability Adjusted Life Years (DALYs) of Injuries
Using Disability Adjusted Life Years to Value the Treatment of Thirty Chronic Conditions in the U.S. from 1987-2010
DALY to money conversion
I still like the very simple calculation of $1000 per dead neuron. At 177 million dead neurons in the first 90 minutes that would cost my stroke hospital 177 billion dollars. I'm excluding the additional 5.4 billion neurons they let die during the
neuronal cascade of death in the first week.
Time is Brain, you know. Maybe you want these much faster objective diagnosis options.
Hats off to Helmet of Hope - stroke diagnosis in 30 seconds; February 2017
Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds March 2017
New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes April 2017
Ski-Mask Design AIR Coil Offers Whole-Brain Imaging Without Claustrophobia
Blood Biomarkers to Differentiate Ischemic and Hemorrhagic Strokes Might Allow Prehospital Thrombolysis
The latest here:
Abstract 17: Time-Benefit Association is Magnified in Door-To-Puncture Window: Lose 1 Second, Lose 2.2 Hours of Healthy Life
Abstract
Background: The benefits of endovascular thrombectomy (EVT) are time dependent. Prior studies may have underestimated the magnitude of the time-benefit relation because time of onset (last known well ”LKW”) is imprecisely known, and analyses including late-arriving patients have under-representation of “fast-progressors.”
Methods: Patient level data were pooled by the HERMES Investigators from all 7 RCTs of stent retriever thrombectomy devices (entirely or predominantly) versus medical therapy. Analysis was confined to early-treated patients (LKW-to-puncture≤4h). Exposures: last known well-to-door (LKWTD) time; door-to-puncture (DTP) time; door-to-reperfusion (DTR) time. Outcomes: stroke-related quality of life at 3m (utility-weighted modified Rankin Scale); years of healthy life lost [disability-adjusted life years (DALYs)].
Results: Among the 781 EVT-treated patients, 406 (52.0%) were treated within 4h of LKW, with LKW-to-Door time median 188 minutes (IQR 151-215) and DTP time 105 minutes (IQR 76-135). Among the 295/372 (79.3%) with substantial reperfusion, DTR time was median 145 minutes (IQR 111-186). Care process delays were more strongly associated with worse clinical outcomes in the DTP and DTR epochs than the LKW-To-Door epoch (Table 1A), e.g., for each 10 minute delay, healthy life-years lost were: DTP 1.8 months vs LKW-to-Door 0.0 months, p < 0.0001. Considering granular time increments, the amount of healthy life-years lost associated with each 1 second of delay was: DTP 2.2 hours, DTR 2.1 hours.(Table 1B)
Conclusion: Post-arrival care delays are strongly associated with worse EVT patient outcomes in the early post-arrival time period. With every 1 second of delay in EVT delivery, patients lose 2.2 hours of healthy life-years. Continuous quality improvement to minimize delays in DTP and DTR for endovascular thrombectomy is warranted.
No comments:
Post a Comment