You're not even measuring 100% recovery. SO YOU EXPECT STROKE SURVIVORS TO ACCEPT YOUR FUCKING TYRANNY OF LOW EXPECTATIONS? Hope you are OK with that when you are
the 1 in 4 per WHO that has a stroke
To me this is all about accepting failure as OK, and make no mistake, not getting to 100% recovery IS FAILURE.
Association Between Dispatch of Mobile Stroke Units and Functional Outcomes Among Patients With Acute Ischemic Stroke in Berlin
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EditorialImproving Stroke Treatment and Outcomes With Mobile Stroke UnitsKristi G. Bache, PhD; James C. Grotta, MD
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Special CommunicationMobile Stroke Unit ProgramSuja S. Rajan, PhD; Sarah Baraniuk, PhD; Stephanie Parker, RN, BSN; Tzu-Ching Wu, MD; Ritvij Bowry, MD; James C. Grotta, MD
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Original InvestigationPrehospital Stroke Management Optimized by the Use of Clinical Scoring vs Mobile Stroke UnitStefan A. Helwig; Andreas Ragoschke-Schumm, MD; Lenka Schwindling; Michael Kettner, MD; Safwan Roumia; Johann Kulikovski; Isabel Keller, MD; Matthias Manitz; Daniel Martens; Daniel Grün, MD; Silke Walter, MD; Martin Lesmeister; Kira Ewen; Jannik Brand; Mathias Fousse, MD; Jil Kauffmann; Valerie C. Zimmer; Shrey Mathur, MD; Thomas Bertsch, MD; Jürgen Guldner, MD; Achim Magull-Seltenreich, MD; Andreas Binder, MD; Elmar Spüntrup, MD; Anastasios Chatzikonstantinou, MD; Oliver Adam, MD; Kai Kronfeld, PhD; Yang Liu, MD; Christian Ruckes, MSc; Helmut Schumacher, PhD; Iris Q. Grunwald, MD; Umut Yilmaz, MD; Thomas Schlechtriemen, MD; Wolfgang Reith, MD, PhD; Klaus Fassbender, MD
Question Is the dispatch of mobile stroke units in the out-of-hospital setting before arriving at the hospital associated with better functional outcomes among patients with acute ischemic stroke eligible for thrombolysis or thrombectomy?
Findings In this prospective nonrandomized controlled intervention study involving 1543 patients in Berlin, Germany, the dispatch of mobile stroke units in addition to conventional ambulances vs conventional ambulances alone was significantly associated with lower levels of global disability at 3 months (common odds ratio for higher modified Rankin Scale scores [ie, worse outcome], 0.71).
Meaning Among patients with acute ischemic stroke in Berlin, Germany, dispatch of a mobile stroke unit was associated with lower global disability at 3 months; further research in diverse settings is needed.
Abstract
Importance
Effects of thrombolysis in acute ischemic stroke are
time-dependent. Ambulances that can administer thrombolysis (mobile
stroke units [MSUs]) before arriving at the hospital have been shown to
reduce time to treatment.(But you still don't know how fast is has to be to get 100% recovered. Shouldn't that be your first step before going down this MSU route?)
Objective To determine whether dispatch of MSUs is associated with better clinical outcomes for patients with acute ischemic stroke.
Design, Setting, and Participants This prospective, nonrandomized, controlled intervention study was conducted in Berlin, Germany, from February 1, 2017, to October 30, 2019. If an emergency call prompted suspicion of stroke, both a conventional ambulance and an MSU, when available, were dispatched. Functional outcomes of patients with final diagnosis of acute cerebral ischemia who were eligible for thrombolysis or thrombectomy were compared based on the initial dispatch (both MSU and conventional ambulance or conventional ambulance only).
Exposure Simultaneous dispatch of an MSU (computed tomographic scanning with or without angiography, point-of-care laboratory testing, and thrombolysis capabilities on board) and a conventional ambulance (n = 749) vs conventional ambulance alone (n = 794).
Main Outcomes and Measures The primary outcome was the distribution of modified Rankin Scale (mRS) scores (a disability score ranging from 0, no neurological deficits, to 6, death) at 3 months. The coprimary outcome was a 3-tier disability scale at 3 months (none to moderate disability; severe disability; death) with tier assignment based on mRS scores if available or place of residence if mRS scores were not available. Common odds ratios (ORs) were used to quantify the association between exposure and outcome; values less than 1.00 indicated a favorable shift in the mRS distribution and lower odds of higher levels of disability.
Results Of the 1543 patients (mean age, 74 years; 723 women [47%]) included in the adjusted primary analysis, 1337 (87%) had available mRS scores (primary outcome) and 1506 patients (98%) had available the 3-tier disability scale assessment (coprimary outcome). Patients with an MSU dispatched had lower median mRS scores at month 3 (1; interquartile range [IQR], 0-3) than did patients without an MSU dispatched (2; IQR, 0-3; common OR for worse mRS, 0.71; 95% CI, 0.58-0.86; P < .001). Similarly, patients with an MSU dispatched had lower 3-month coprimary disability scores: 586 patients (80.3%) had none to moderate disability; 92 (12.6%) had severe disability; and 52 (7.1%) had died vs patients without an MSU dispatched: 605 (78.0%) had none to moderate disability; 103 (13.3%) had severe disability; and 68 (8.8%) had died (common OR for worse functional outcome, 0.73, 95% CI, 0.54-0.99; P = .04).
Conclusions and Relevance In this prospective, nonrandomized, controlled intervention study of patients with acute ischemic stroke in Berlin, Germany, the dispatch of mobile stroke units, compared with conventional ambulances alone, was significantly associated with lower global disability at 3 months. Clinical trials in other regions are warranted.
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