Stroke Treatment in Critical “Golden Hour” More Likely in Mobile Stroke Units
By Nancy Melville
YORK, Me -- March 24, 2021 -- Patients who receive stroke treatment in a mobile stroke unit are significantly more likely to receive potentially life-saving clot-buster treatment, to receive treatment within 1 hour of stroke onset, and to achieve a full recovery than those treated in a standard ambulance, according to a study presented at the 2021 Virtual International Stroke Conference (ISC).
“More widespread deployment of mobile stroke units may have a major public health impact on reducing disability from stroke,” said James C. Grotta, MD, Clinical Institute for Research and Innovation at Memorial Hermann, Texas Medical Center, Houston, Texas. “Although mobile stroke units are costly to equip and staff, they reduce the time to treatment. We also expect that more treatment via mobile stroke units can reduce the need for downstream utilisation of long-term care.”
The study, part of the ongoing Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit (BEST-MSU) study, involved 1,047 patients who had experienced an ischaemic stroke and were transported to the emergency department either in a mobile stroke unit (n = 617) or by standard emergency medical services (n = 430).
The patients, all eligible for treatment with tissue plasminogen activator (tPA), were treated between 2014 and 2020 at 7 centres around the United States.
Although nearly all (97.1%) patients transported in the mobile stroke unit who qualified for tPA received the treatment within 4.5 hours of symptom onset, the rate was only 79.1% among those transported in a standard ambulance (P
“Getting patients treated within the first hour in the emergency room setting is extremely difficult and occurs only rarely,” said Dr. Grotta.
The study’s primary outcome, a mean utility-weighted modified Rankin scale (mRS) score, was 0.728 among patients in the mobile stroke unit versus 0.657 of those transported by standard ambulance (P = .002). The odds of achieving a complete recovery, with a mRS of 0 to 1 after 3 months, was 2.43 in favour of patients treated by the mobile stroke unit (P
“For every 100 patients treated with a mobile stroke unit rather than standard ambulance, 27 will have less final disability, and 11 more will be disability-free, with an mRS of 0 to 1,” said Dr. Grotta. “Our study confirmed that patients who are treated early benefit from a complete reversal of stroke symptoms and avoidance of disability.”
Further findings regarding outcomes and health care utilisation with the mobile stroke unit are due to be reported later in 2021.
ISC is sponsored by the American Heart Association and the American Stroke Association.
[Presentation title: Benefits of Stroke Treatment Delivered by a Mobile Stroke Unit Compared to Standard Management by Emergency Medical Services (BEST-MSU Study). Abstract LB2]