Patients with stroke symptoms attended by a mobile stroke unit (MSU) have an 18% chance of averting a stroke vs an 11% chance with traditional emergency medical services (EMSs), a new study shows. Investigators believe that these improved outcomes are likely due to a speedier response by MSUs and specialized ambulances equipped with the personnel, equipment, and imaging needed to diagnose and treat acute stroke in a prehospital setting.
The prospective, multicenter trial included 1009 patients (median age, 66 years; 50% men) from seven US sites who were followed between 2014 and 2020 and received treatment from the mobile stroke unit (n = 644) or standard management (SM) with EMS (n = 365) upon presentation of signs and symptoms of acute ischemic stroke.
Patients in both groups were treated with intravenous tissue plasminogen activator (tPA), the most common reperfusion therapy.
Final diagnoses were determined by the local study physician or nurse practitioner investigators, all of whom were board-certified neurovascular vascular neurologists or board-certified nurse practitioners trained in stroke diagnosis.
The primary outcome was a tissue-defined averted stroke, and an additional outcome was stroke with early symptom resolution.
Compared with SM, MSU care was associated with more tissue-defined averted stroke (18% vs 11%; adjusted odds ratio [aOR], 1.82; P = .02).
Patients received tPA 37 minutes faster with MSU care vs SM, which increased the odds of averting stroke even further, with nearly one third of these patients recovering to normal within 24 hours.
MSU was also associated with greater early symptom resolution when compared with SM (31% vs 21%; aOR, 1.74; P = .007).
Younger age, female gender, hyperlipidemia, lower score on the National Institutes of Health Stroke Scale, lower blood pressure, and no large vessel occlusion were associated with both tissue-defined averted stroke and stroke with early symptom resolution.
“When intravenous thrombolysis is administered expeditiously, approximately 1 in 4 patients with stroke will recover to their neurological baseline within 24 hours and 1 in 6 will have no demonstrable brain injury on imaging. MSUs, which expedite thrombolysis, further increase the odds of averting stroke as compared with SM,” the authors write.
Babak B. Navi, MD, of Weill Cornell Medicine in New York, led the study, which was published online on October 6, 2023 in the Annals of Neurology. The study was funded by the Patient-Centered Outcomes Research Institute.
The study relied on clinical diagnoses that depended on the individual characteristics and evaluations of patients and the skills and biases of local investigators, so some diagnoses classified as averted/early recovered stroke may have actually been transient ischemic attacks or mimics and vice versa. Also, MRI, which is considered the gold standard for determining stroke, was only performed in 74% of patients.
Disclosures are noted in the original article.
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