Management by mobile stroke unit led to better functional outcomes vs. standard ambulance
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Patients who experienced a stroke and were treated by a mobile stroke unit were more likely to be treated within the first hour of symptom onset and more likely to be disability free at 90 days, a researcher reported.
According to data from the BEST-MSU trial presented at the virtual International Stroke Conference, mobile stroke units were able to administer clot-busting tissue plasminogen activator to more eligible patients within 4.5 hours compared with a standard ambulance.
“Our goal in this study was to treat patients on the mobile stroke unit within an hour of the onset of their stroke symptoms, and we were gratified that one-third of the patients were actually treated within that time frame,” James C. Grotta, MD, director of stroke research at the Clinical Institute for Research and Innovation at Memorial Hermann Texas Medical Center in Houston, said in a press release. “Our study confirmed that patients who are treated early benefit from a complete reversal of stroke symptoms and avoidance of disability. This suggests that in the first hour after a stroke occurs, the brain is not yet irreversibly damaged and is very amenable to effective treatment.”
For the multicenter randomized trial, researchers evaluated 90-day functional outcomes of 1,047 tissue plasminogen activator (tPA)-eligible patients managed by a mobile stroke unit compared with standard ambulance. The primary outcome of the BEST-MSU study was utility-weighted modified Rankin Scale score at 90 days. To compare stroke management modalities, mobile stroke units and standard ambulances were dispatched on alternating weeks.
This trial was conducted at seven centers in Houston; Aurora, Colorado; New York City; Indianapolis; Los Angeles; Memphis, Tennessee; and Burlingame, California.
Researchers reported that approximately 33% of patients treated by a mobile stroke unit were treated within the first hour after symptom onset compared with 3% of patients treated by standard ambulance.
“Getting patients treated within the first hour in the emergency room setting is extremely difficult and only occurs rarely,” Grotta said during a press conference. “The 33% was consistent with what was found in other studies with mobile stroke units.”
According to the presentation, the mobile stroke units were equipped with a CT scanner, point-of-care laboratory equipment and personnel trained to diagnose and treat tPA-eligible stroke in the pre-hospital setting and triage them for endovascular therapy.
Within the 4.5-hour window of symptom onset, the mobile stroke unit was able to provide tPA therapy to 97.1% of eligible patients compared with 79.1% for the standard ambulance (P < .001).
According to the presentation, patients treated by the mobile stroke units had better 90-day functional outcomes compared with those treated by standard ambulance (mean utility-weighted modified Rankin Scale score, 0.726 vs. 0.657; difference = .069; P = .002).
At 90 days, researchers observed that patients with stroke managed by a mobile stroke unit were more likely to have a modified Rankin Scale score of 0 or 1 compared with management by standard ambulance (OR = 2.43; P < .001); propensity score matching did not change the results.
“Putting this in perspective, if you treated 100 patients with a mobile stroke unit rather than standard management, 27 will have less final disability and 11 more would be disability free, achieving a Rankin score of 0 or 1,” Grotta said during the press conference.
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Grotta J, et al. Late-Breaking Science I. Presented at: International Stroke Conference; March 17-19, 2021 (virtual meeting).
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