Hybrid-Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond

Area of Science:

• Emergency Medicine
• Neurology
• Public Health

Background:

• Mobile Stroke Units (MSUs) show benefits but face integration challenges, particularly in nonurban settings.
• Expanding MSU indications to include stroke mimics and other emergencies is proposed to enhance utility.
• Concerns exist regarding the cost-effectiveness and clinical integration of single-purpose MSUs.

Purpose of the Study:

• To evaluate the benefits of a Hybrid-MSU with extended diagnostic and treatment capabilities.
• To assess the impact of the Hybrid-MSU on prehospital treatment and triage decision-making for a broader range of conditions.
• To determine the feasibility of integrating advanced prehospital care into routine healthcare.

Main Methods:

• An observational study comparing 250 patients treated by a Hybrid-MSU with 250 conventionally treated patients.
• The Hybrid-MSU was equipped with radiography, ultrasonography, advanced point-of-care lab tests, ECG, EEG, and advanced medications.
• The Hybrid-MSU responded to stroke codes as well as codes for seizures, falls with head trauma, headache, unconsciousness, infection, chest pain, and breathing problems.

Main Results:

• The Hybrid-MSU facilitated prehospital administration of thrombolytics, anticonvulsants, antibiotics, aspirin, and the Sepsis Six bundle.
• Prehospital diagnosis and treatment by the Hybrid-MSU avoided emergency department admission for 86.0% of patients.
• Patients were either managed at home (46.4%) or directly transferred to specialized wards (39.6%).

Conclusions:

• The Hybrid-MSU demonstrates feasibility and potential benefits for prehospital treatment and triage.
• Expanding the scope of indications and enabling autonomous operation are key for integrating MSUs into routine care.
• Advanced prehospital care via Hybrid-MSUs can optimize patient management and reduce healthcare system burden.