"Compared with usual care, mobile stroke unit use was associated with an approximately 65% increase in the odds of excellent outcome and a 30-minute reduction in onset-to-intravenous thrombolysis times, without safety concerns," the study team reports in JAMA Neurology.
A mobile stroke unit (MSU) is a specialized ambulance equipped with a portable CT scanner, laboratory, telemedicine capabilities and neurological expertise, allowing onboard staff to quickly diagnose ischemic stroke and administer thrombolytic therapy with tissue plasminogen activator (tPA) while en route to the hospital.
Dr. Guillaume Turc with GHU Paris Psychiatry and Neurosciences and colleagues did a systematic review and meta-analysis of 14 reports on studies (including three randomized controlled trials) comparing MSU care with usual care in patients with acute ischemic stroke.
Compared with usual care, MSU care was associated with excellent outcome defined as a modified Rankin Scale (mRS) score of 0 to 1 (adjusted odds ratio, 1.64; P<0.001), reduced disability over the full range of the mRS (adjusted common OR, 1.39; P=0.001) and good outcome (mRS score of 0 to 2: crude OR, 1.25; P=0.001), the study team reports.
MSU care was also associated with shorter time to intravenous thrombolysis (median reduction, 31 minutes; P<0.001) and IV thrombolysis within 60 minutes of symptom onset (crude OR, 7.71).
MSU care was not associated with an increased risk of death at seven days or at 90 days or with higher proportions of symptomatic intracranial hemorrhage after thrombolytic therapy.
"These results should help guideline writing committees and decision makers to shape the future of prehospital stroke care," the authors write.
They acknowledge that MSU care is associated with costs and requires optimal integration into regional emergency response services.
"Further studies will be needed to determine in which local environments the deployment of MSUs would be the most useful," they add.
SOURCE: https://bit.ly/3uFrdOF JAMA Neurology, online February 7, 2022.
By Reuters Staff
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