Entering new fields of simulation application - challenges faced in simulation modelling of stroke systems

Stroke is a major cause of death and long-term disability world-wide. To improve functional outcome treatment with intravenous tissue plasminogen activator (tPA) is the most effective medical treatment for acute brain infarction within 4.5 hours after the onset of stroke symptoms. Unfortunately, tPA remains substantially underutilized. Acute stroke care organization is among the dominant factors determining undertreatment. Recently, simulation has been suggested and successfully implemented as a tool for optimizing stroke care pathway logistics. Starting from a number of pioneering simulation studies challenges in simulation application and simulation methodology are identified. The definition of a domain specific modelling framework for acute stroke care is advocated to master system complexities, facilitate joint team work in solution finding, organize model data collection and make a further entrance to the field.