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Transfer (Drip & Ship) vs Direct Mothership. Moderate collaterals. · causal decision support for acute stroke pathways

You changed (A)time: 160 → 250This shifted (M) time-to-reperfusion 250 min (+90 min)This caused (Y) core 110 cc (+31 cc) → independence -13%

Intervention levers (A)

Routing

Transfer delay60 min
Door-to-groin at EVT centre70 min
IVT workflow delay5 min
SBP target150 mmHg

Patient phenotype (X)

Age 72 MNIHSS 18Left M1Collaterals 1.5/3Core₀ 25 cc
Core growth speed4/5
Reperfusion difficulty1/5
Haemorrhage vulnerability4/5

Multimodal imaging

1.0x
CT Perfusion

Ischaemic topography · scroll to zoom, drag to pan

Tissue fate

27ccsaved/ 150cc
Core Salvaged Lost penumbra

Brain volumes before vs after

Outcomes

Time-to-reperfusion sensitivity

Causal logic & mechanism

Phenotype (X)Routing /Transfer (A)Time-to-reperfusion(M)Collaterals(modifier)Core growth (M)Outcome (Y)

Hover a node to see what it represents. Highlighted nodes are the pathway active in this case.

What changed causally?The phenotype (X) stays fixed; only the action (A) moves. The simulator propagates that through time-to-reperfusion, core growth, reperfusion probability and haemorrhage risk. Net effect: -13% probability of good functional outcome, with sICH risk at 20%.

Contribution breakdown (why the outcome changed)

Clinical explanation for patient & family

Transfer adds delay, but early clot-busting treatment may still help some patients. This option is projected to result in a poorer outcome (-13% change in independence).

Intervention effects

MetricValueΔ vs base
Time-to-reperfusion250min+90min
Final core110cc+31cc
Reperfusion probability86%0%
Penumbra salvaged27cc-21cc
Functional outcome0%-13%
Mortality risk27%+5%
sICH risk20%+3%

Consultation note

Baseline pathway: 13% independence, 22% mortality, 17% symptomatic bleed.

Current plan: 0% independence, 27% mortality, 20% symptomatic bleed, reperfusion probability 86%.

Simulation is illustrative decision support, not a substitute for clinical judgement or trial evidence.