Mobile stroke unit versus standard medical care in the management of patients with acute stroke: A systematic review and meta-analysis

And why would you want to roll out something that slow? Incompetently didn't know about faster options? Not your job to keep up with current stroke research?

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Mobile stroke unit versus standard medical care in the management of patients with acute stroke: A systematic review and meta-analysis

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Nida Fatima, Maher Saqqur, M Shazam Hussain, ...

First Published June 9, 2020 Review Article Find in PubMed 

https://doi.org/10.1177/1747493020929964

Article information

 

Abstract

Introduction

Mobile stroke units have recently been introduced in the care of patients suspected of having an acute stroke, leading to shortening in the time to thrombolytics. We aimed to compare the clinical effectiveness in terms of functional outcome and survival among patients treated in mobile stroke unit and/or conventional care.

Methods

A systematic search of electronic databases, comparing the clinical outcomes among patients with acute stroke in the same study was conducted from 1990 to 2019. Pooled and subgroup analysis were performed using the random- and fixed-effect model based upon the I² heterogeneity.

Results

A total of 21,297 patients from 11 publications (seven randomized controlled trials and four non-randomized controlled trials including prospective cohort studies) were retrieved. This included 6065 (n = 28.4%) of the patients treated in the mobile stroke unit and 71.6% (n = 15,232) of the patients managed in the conventional care. The mean age at clinical presentation (70.1 ± 14.5 vs. 71.05 ± 15.8) and National Institute Health Stroke Scale (9.8 ± 1.7 vs. 8.4 ± 1.5) was comparable (p > 0.05) in patients treated with mobile stroke unit and conventional care, respectively. The mean time-to-treatment window was significantly shorter among the patients treated in mobile stroke unit compared to conventional care (62.0 min vs. 75.0 min; p = 0.03, respectively). The pooled analysis of clinical outcome at day 7 indicated that patients treated in mobile stroke unit had 1.46-folds higher likelihood of better clinical outcome (modified Rankin scale 0–2) than those in the hospital (odds ratio: 1.46, 95% confidence interval: 1.306–2.03, p = 0.02). However, there was no significant difference in terms of mortality (odds ratio: 0.98, 95% confidence interval: 0.81–1.18, p = 0.80), stroke-related neurological deficits (odds ratio: 1.37, 95% confidence interval: 0.81–2.32, p = 0.24), and other serious adverse events (odds ratio: 0.69, 95% confidence interval: 0.39–1.20, p = 0.19) among patients treated in mobile stroke unit versus conventional care.

Conclusion

Our results corroborate that patients treated in mobile stroke unit lead to short-term recovery following acute stroke without influencing the mortality rate. Further prospective studies are needed to validate our results.

Keywords Acute stroke, mobile stroke unit, conventional care, thrombolytics

Introduction

Stroke care has significantly improved due to recent technological innovations in the form of imaging (CT- and MRI) and high-speed wireless data transmission, resulting in better outcomes as reflected by reduced mortality and morbidity.¹ Perhaps the most important factor in determination of clinical outcome following stroke is the “time to reperfusion,”² which has been significantly reduced due to management of patients in the mobile stroke unit (MSU).³ Since these MSUs are equipped with necessary imaging technique and laboratory testing equipments along with a well-trained designated MSU staff, thus early access and management to eligible stroke patients have been made.^4,5 Several studies have reported on better time to treatment and improved outcome with MSUs.^6–8 Furthermore, MSU also provides “accurate triage decision”⁹ to stroke patients. This prehospital management involves transport to comprehensive stroke center (CSC) for patients with large vessel occlusion or intracranial hemorrhage (ICH) and to a noncomprehensive stroke center for patients with other stroke syndromes. The resulting hospital transfers considerably reduce costs and detrimental delays before treatment.⁹

To date, no one of the meta-analysis has been conducted to evaluate the difference in terms of time gains and clinical outcome among patients treated in the MSU versus standard conventional care. Hence, we aimed to do meta-analysis to determine the safety and efficacy of the treatment given to the patients in MSU versus standard conventional care. Our a priori hypothesis is that the patients treated in MSU exhibit better(NOT GOOD ENOUGH) short- and long-term clinical outcome and better survival rate.(But did they get to 100% recovery?  You're not even measuring the correct endpoint.)