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Prospective, Multicenter, Controlled Trial of Mobile Stroke Units
James C Grotta1, Jose-Miguel Yamal1, Stephanie A Parker1
1From the Mobile Stroke Unit, Memorial Hermann Hospital-Texas Medical Center (J.C.G., J. McCarthy, T.F.), the Departments of Biostatistics and Data Science (J.-M.Y., A.P.J., M.W., N.S., M.G.) and Management, Policy, and Community Heath (S.S.R.), University of Texas School of Public Health, the Departments of Neurology (S.A.P., N.R.G., P.L.B., N.R.-G., E.L., J.S., K.P., Y.S., E.A.N., R.B.) and Emergency Medicine (D.P.), University of Texas McGovern Medical School, the Departments of Emergency Medicine (D.P.) and Neurology (C.P.V.R.), Baylor College of Medicine, the Department of Neurology, Houston Methodist Hospital (D.C., J.V., V.M.), the Department of Neurology, Harris Health-Ben Taub General Hospital (J.S.K.), and HCA Houston Healthcare (L.G.) - all in Houston; the Department of Neurology, University of Colorado, UCHealth Anschutz Medical Campus, Aurora (W.J.J., B.D.S., K.A., M.E., D.O.), and the Department of Neurology, UCHealth Memorial Hospital, Colorado Springs (J. Miller) - both in Colorado; the Department of Neurology, University of Tennessee Health Science Center, Memphis (A.W.A., A.V.A., J.P.R.); the Department of Neurology, Weill Cornell Medicine (B.B.N., M.E.F., C.S., M.L., S.M.), and the Department of Neurology, Columbia University Irving Medical Center (J.Z.W.) - both in New York; the Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles (M.N., J.L.S., K.M.B., B.M.V.), the Department of Neurology, Mills Peninsula Medical Center, Burlingame (I.S., J.E., N. Barazangi, J.I.), Los Angeles County Emergency Medical Services, Santa Fe Springs (M.G.-H., N. Bosson), and San Mateo County Emergency Medical Services, South San Francisco (G.G.) - all in California; and the Department of Neurology, Indiana University School of Medicine, Indianapolis (J. Mackey, S.Q.C., K.S.).
Mobile stroke units (MSUs) significantly improved outcomes for acute stroke patients eligible for tissue plasminogen activator (t-PA). MSUs reduced treatment times and disability scores compared to standard emergency medical services (EMS).
Area of Science:
- Neurology
- Emergency Medicine
- Public Health
Background:
- Mobile stroke units (MSUs) equipped with CT scanners may expedite treatment for acute stroke patients.
- The impact of MSUs on patient outcomes compared to standard emergency medical services (EMS) requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of MSUs in improving outcomes for acute stroke patients.
- To compare treatment times and functional outcomes between MSU and EMS management.
Main Methods:
- An observational, prospective, multicenter, alternating-week trial compared MSU and EMS care for acute stroke.
- The primary outcome was the utility-weighted modified Rankin scale score at 90 days, focusing on patients eligible for tissue plasminogen activator (t-PA).
Main Results:
- MSU care led to a median t-PA administration time of 72 minutes versus 108 minutes for EMS.
- Patients treated by MSUs showed significantly better 90-day utility-weighted modified Rankin scale scores (0.72 vs. 0.66) and a higher rate of favorable outcomes (55.0% vs. 44.4% with modified Rankin scale score ≤1).
- Mortality at 90 days was lower in the MSU group (8.9%) compared to the EMS group (11.9%).
Conclusions:
- Mobile stroke units demonstrate superior outcomes in terms of functional disability at 90 days for acute stroke patients eligible for t-PA.
- MSU treatment resulted in faster administration of t-PA and improved functional recovery compared to standard EMS care.
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