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In What Scenarios Does a Mobile Stroke Unit Predict Better Patient Outcomes?: A Modeling Study
Jessalyn K Holodinsky1, Noreen Kamal2, Charlotte Zerna3,4,5
1From the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada (J.K.H.).
Stroke
|May 12, 2020
Summary
Mobile stroke units (MSUs) offer limited advantages over direct-to-hospital transport for stroke patients. Optimal outcomes depend on rapid MSU treatment times and broad dispatch criteria to maximize eligible patients.
Area of Science:
- Neurology
- Emergency Medicine
- Health Services Research
Background:
- Mobile stroke units (MSUs) deliver advanced stroke care, including imaging and thrombolysis, directly to patients.
- The effectiveness of MSUs is contingent upon patient and unit location, impacting treatment timelines.
- MSUs can only treat a fraction of the patients to whom they are dispatched.
Purpose of the Study:
- To evaluate scenarios where MSUs provide a distinct benefit compared to the direct-to-hospital (mothership) transport method.
- To analyze the impact of dispatch criteria and on-scene treatment efficiency on MSU effectiveness.
Main Methods:
- Modified existing conditional probability models to incorporate MSU workflow.
- Simulated eight scenarios varying MSU and hospital treatment efficiency and dispatch thresholds.
- Assumed MSU dispatch originated from an endovascular therapy center.
Main Results:
- The difference in patient outcomes between MSU and mothership transport was generally small.
- MSU superiority was observed in larger geographic areas when on-scene treatment times were reduced.
- A high-threshold dispatch system reduced the area of MSU advantage but increased the outcome difference when superior.
Conclusions:
- Few situations demonstrate substantially superior outcomes with MSU transport compared to the mothership method when dispatched from a treatment center.
- Maximizing MSU benefits requires dispatch criteria that include more patients eligible for thrombolysis and shorter on-scene treatment durations.
