Mobile Stroke Units Linked to Improved Acute Stroke Outcomes

TOPLINE: 

Patients with acute ischemic stroke treated in mobile stroke units have better outcomes, with lower global disability scores, faster thrombolysis times, and comparable safety outcomes, than those receiving standard emergency medical services (EMS) care.

METHODOLOGY:

• This retrospective study included 19,433 patients with acute ischemic stroke (median age, 73 years; 50.8% women) from 106 US hospitals between 2018 and 2023 who were potentially eligible for intravenous thrombolysis and received prehospital care from mobile stroke units (n = 1237) or standard EMS (n = 18,196).
• The primary outcome was the level of global disability at discharge measured using utility-weighted modified Rankin Scale (UW-mRS) scores, with higher scores indicating better quality of life.
• The secondary outcome was independent ambulation at discharge, and the safety endpoints were symptomatic intracranial hemorrhage and in-hospital death.

TAKEAWAY:

• Patients who received prehospital treatment in mobile stroke units had better global disability scores than those who received standard EMS management (mean score, 0.51 vs 0.47; adjusted mean difference, 0.03), along with higher rates of nondisabled outcomes (mRS 0-1) and functional independence (mRS 0-2) at discharge.
• Patients who were treated in mobile stroke units showed higher rates of independent ambulation at discharge than those who received standard EMS care (53.3% vs 48.3%; adjusted relative risk (aRR), 1.08; 95% CI, 1.03-1.13).
• Patients who received mobile stroke unit care were more likely to be treated with intravenous thrombolysis than those who received standard EMS care (84.6% vs 66.4%; aRR, 1.26; 95% CI, 1.22-1.29), with a shorter time to thrombolysis initiation (103 vs 119 minutes).
• The rates of symptomatic intracranial hemorrhage and in-hospital mortality were not significantly different between the two groups.

IN PRACTICE:

“Among patients with acute ischemic stroke potentially eligible for intravenous thrombolysis, prehospital management in an MSU [mobile stroke unit] compared with standard EMS management was associated with a significantly lower level of global disability at hospital discharge. These findings support policy efforts to expand access to prehospital MSU management, ” the authors wrote.”These findings remained durable when all patients with ischemic stroke and all patients who presented acutely, regardless of intravenous thrombolysis eligibility, were analyzed,” they added. 

SOURCE:

The study was led by Brian Mac Grory, MB BCh BAO, MHSc, Duke University School of Medicine, Durham, North Carolina, and published online on October 28, 2024, in JAMA Neurology.

LIMITATIONS: 

The limitations of this study included reliance on a quality improvement registry, which may not capture all details, and sole focus on hospitals in the Get With The Guidelines (GWTG)–Stroke program, both of which limited the generalizability of the findings. Differences between patient groups may not have been fully accounted for, and incomplete data on prehospital care and timing of the first medical contact likely introduced a conservative bias by excluding patients with standard EMS management who missed thrombolysis due to delayed arrival.

DISCLOSURES:

The study was funded by an Early Career Investigator Award from the American Heart Association (AHA). One author reported receiving grants from the National Institutes of Health (NIH) and the AHA. The GWTG–Stroke program, provided by the AHA and American Stroke Association, was sponsored by Novartis, Novo Nordisk, AstraZeneca, Bayer, and others. Other authors received grants, honoraria, advisory board fees and consultant fees, and other funding from various sources; details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.