The Science Behind DESTINE Health

Ischemic stroke is a devastating disease which without appropriate treatment can result in severe disability or death. There are two treatments for ischemic stroke:

1) medical treatment with intravenous alteplase
2) a minimally invasive surgical procedure, endovascular therapy (EVT)

Alteplase is widely available at smaller community hospitals; however, is not very effective. Endovascular therapy is only available at urban tertiary hospitals, but is highly effective. Both treatments are time sensitive. For patients outside of the catchment area of an EVT centre there are two transport options:

1) transport to the closest hospital for alteplase and then transfer to an EVT capable hospital for EVT (drip-and-ship)
2) direct transport to an EVT capable hospital (bypassing a closer community hospital) for alteplase and EVT (mothership)

The choice between drip-and-ship and mothership transport is multi-factorial and there is not one size fits all solution.

DESTINE is an interactive decision support tool which uses an evidence-based algorithm to predict whether drip-and-ship or mothership transport will result in the best patient outcomes at the population level. This is a complex decision based on several factors including: geography, travel time, hospital treatment efficiency, and the probable diagnostic distribution of potential stroke patients identified in the field by EMS. DESTINE takes this complex problem and produces a simple visualization which can be used as a decision support tool to assist healthcare administrators in planning their stroke systems. DESTINE software is interactive and cloud-based; it uses a proprietary algorithm based off years of peer-reviewed research to create map visualizations. Healthcare administrators use these maps to create evidence-based transport protocols for their stroke systems. The maps further show how transport protocols change as stroke system efficiency or hospital treatment designation changes.

DESTINE Health was born as an academic project in the Departments of Clinical Neurosciences and Community Health Sciences at the University of Calgary. To read more about the science behind DESTINE Health please see the below academic publications.

Scientific Advisory Comittee

Dr. Michael Hill

Professor, Cumming School of Medicine, University of Calgary; Stroke Neurologist, Foothills Medical Centre

Dr. Mahesh Jayaraman

Associate Professor, Warren Alpert Medical School of Brown University; Director Neurovascular Center; Sr Member, Society of NeuroInterventional Surgery

Dr. Michael Mazya

Consultant in Neurology, Karolinska University Hospital; Chair, Swedish Acute Neurology Society

Dr. Ryan McTaggart

Associate Professor Warren Alpert Medical School of Brown University; Director Interventional Radiology

Dr. Bijoy Menon

Associate Professor, Cumming School of Medicine, University of Calgary; Stroke Neurologist, Foothills Medical Centre

Peer-Reviewed Publications

1. Ernst M, Psychogios M-N, Schlemm E, Holodinsky JK, Kamal N, Rodt T, et al. Modeling the Optimal Transportation for Acute Stroke Treatment: Impact of Diurnal Variations in Traffic Rate. Clin Neuroradiol. Springer Berlin Heidelberg; 2020 Jul 16;384(9958):1929–8; doi:10.1007/s00062-020-00933-y
2. Ernst M, Schlemm E, Holodinsky JK, et al. Modeling the Optimal Transportation for Acute Stroke Treatment: The Impact of the Drip-and-Drive Paradigm. Stroke. 2020;51(1):275-281. doi:10.1161/STROKEAHA.119.027493.
3. Holodinsky JK, Francis MJ, Goyal M, Hill MD, Kamal N. Testing the Usability of a Software for Geospatial and Transport Modeling in Acute Stroke Service Planning. Front Neurol. 2019;10:694. doi:10.3389/fneur.2019.00694.
4. Holodinsky JK, Williamson TS, Demchuk AM, et al. Modeling Stroke Patient Transport for All Patients With Suspected Large-Vessel Occlusion. JAMA Neurol. 2018;75(12):1477-1486. doi:10.1001/jamaneurol.2018.2424.
5. Kamal N, Wiggam MI, Holodinsky JK, et al. Geographic modeling of best transport options for treatment of acute ischemic stroke patients: applied to policy decision making in the USA and Northern Ireland. IISE Transactions on Healthcare Systems Engineering. 2018;8(3):220-226. doi:10.1080/24725579.2018.1501623.
6. Holodinsky J, Patel A, Thornton J, Kamal N, Jewett L, Kelly P, Murphy S, Collins R, Walsh T, Cronin S, Power S, Brennan P, O’Hare A, McCabe D, Moynihan B, Looby S, Wyse, G, McCormack J, Marsden P, Harbison J, Hill M, Williams D. Drip 'N Ship Versus Direct to Endovascular Thrombectomy: The Impact of Treatment Times on Transport Decision Making. European Stroke Journal. 2018; 3(2):126-135; doi: 10.1177/2396987318759362
7. Holodinsky J, Williamson T, Kamal N, Mayank D, Hill M, Goyal M. Drip ‘N Ship vs. Direct to Comprehensive Stroke Centre: Conditional Probability Modeling. Stroke. 2017; 48(1):233-238; doi: 10.1161/STROKEAHA.116.014306
8. Milne M, Holodinsky J, Hill M, Nygren A, Qui C, Goyal M, Kamal N. Drip ‘n Ship vs. Mothership for Endovascular Treatment: Modeling the Best Transportation Options for Optimal Outcomes. Stroke. 2017; 48(3):791-794; doi: 10.1161/STROKEAHA.116.015321

Conference Abstracts

1. Holodinsky J, Zhao H, Francis M, Zhu L, Yassi N, Davis S, Campbell B, Hill M, Kamal N. Modelling the Use of a New Large Vessel Occlusion Screening Tool for Ischemic Stroke Transport Decision Making in Victoria, Australia. European Stroke Journal. 2018; 3(1_suppl): 277