Mobile units provide faster care, better outcomes in acute ischemic stroke

Compared with standard care, use of mobile units sharply increased the odds of positive outcomes and reduced treatment times for acute ischemic stroke, according to a systematic review and meta-analysis published in JAMA Neurology.

“Safety and effects on shortening time to thrombolysis have been investigated across [mobile stroke unit (MSU)]

implementations in different settings and countries,” Guillaume Turc, MD, of the neurology department at GHU Paris Psychiatrie et Neurosciences, and colleagues wrote. “Although time savings were substantial, it remained unclear whether and to what extent earlier treatment would translate to better clinical outcomes.”

Researchers, seeking to ascertain whether MSU usage is associated with positive outcomes in patients with acute ischemic stroke, searched MEDLINE, Cochrane Library and Embase for studies published between 1960 and 2021 that compared MSU deployment with usual care for patients with suspected stroke. They measured outcomes with the modified Rankin Scale (mRS; excellent = score of 0 to 1 at 90 days; good = score of 0 to 2).

Results showed that MSU use was associated with excellent outcome (adjusted OR = 1.64; 95% CI, 1.27-2.13; five studies; n=3,228), reduced disability over the full range of the mRS (adjusted common OR= 1.39; 95% CI, 1.14-1.70; 3 studies; n=1,563), good outcome (crude OR= 1.25; 95% CI, 1.09-1.44; 6 studies; n=3266), shorter onset to intravenous thrombolysis (IVT) times (median reduction = 31 minutes; 95% CI, 23-29; 13 studies; n = 3,322), delivery of IVT (crude OR = 1.83; 95% CI, 1.58-2.12; 7 studies; n=4,790) and IVT within 60 minutes of symptom onset (crude OR = 7.71; 95% CI, 4.17-14.25; 8 studies; n=3,351).

In addition, data revealed MSU use did not correlate with increased risk for all-cause mortality at 7 days, 90 days or with greater proportions of symptomatic intracranial hemorrhage following IVT.

“These results should help guideline writing committees and decision makers to shape the future of prehospital stroke care,” Turc and colleagues wrote. “However, MSU implementation 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.”