A "hub-and-spoke" transfer model and telemedicine-assisted CT can improve patient access to stroke care, according to a study published on 4 February in Lancet Regional Health.
"Leveraging CT-equipped hospitals with telemedicine could enable timelier thrombolysis within a 'hub-and-spoke model,'" wrote a team led by Dr. Lars Masanneck, of University Hospital and Medical Faculty University Hospital Düsseldorf in Germany. (The hub-and-spoke model provides services to outlying points from a central hub.)
"Timely reperfusion offers the greatest benefit in acute ischaemic stroke within the first hour after onset," the authors wrote. They noted, however, that "geographic disparities in stroke care access persist across Germany" and that "nationwide data that quantify existing care gaps or systematically investigate the benefit of early imaging with subsequent thrombolysis in locally accessible, CT-equipped hospitals with telemedicine are lacking."
The investigators conducted an analysis that included data from national facility registries and hospital quality reports from 2023, collecting this data from February to July 2025. The information included 1,475 CT-equipped hospitals, 463 "stroke-ready hospitals" (that is, those that treat at least 100 or more annual cases of "complex neurological treatment of acute stroke"), and 349 certified stroke units.
The researchers modeled driving time access up to 60 minutes in five-minute intervals and simulated variations in ambulance speed or any other hospital delays when using the hub-and-spoke scenario; they also compared hub-and-spoke to direct transfer to specialized hospitals.
Overall, the group reported that, within 30 minutes, nearly all residents (98.9%) could reach a CT-equipped hospital and 90% a stroke-ready hospital, but only 85% a certified stroke unit.
But the team also found benefits to the hub-and-spoke pathway, noting that compared with direct transfer to a stroke unit, this framework would allow 36.4% of inhabitants to start imaging 10 minutes sooner, and for 14.2% it could save 20 minutes to initiation of stroke care.
The hub-and-spoke model could be particularly helpful in rural areas, according to the authors.
"Open questions regarding implementation [of this model] and economics should be investigated," they concluded.
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