Mobile Stroke Units Improve Outcomes, Data Show

 NOT GOOD ENOUGH! Why are you accepting failure to 100% recover as a success? That to me is complete failure and survivors would agree. No excuses allowed. Don't cry to me that brain research is hard. Recovery is way harder than that.

Hope you are OK with failure to recover when you are the 1 in 4 per WHO that has a stroke.

Mobile Stroke Units Improve Outcomes, Data Show

By Thomas R. Collins

March 19, 2021

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​Stroke patients treated by mobile stroke units received faster treatment and had better outcomes  (Whoopee! NOT 100% RECOVERY.)compared to patients who arrived in the standard way to emergency departments (EDs), according to results presented at the International Stroke Conference 2021.

James C. Grotta, MD, FAAN, director of stroke research at the Memorial Hermann-Texas Medical Center and the primary author of the study, said the findings demonstrate the benefits of mobile stroke units, adding to the evidence base that could lead to reimbursement to make their use more widespread.

“A mobile stroke unit is a primary stroke center, basically," Dr. Grotta told Neurology Today At the Meetings. “We get everything done that needs to be done at a primary stroke center."

Mobile units are ambulances equipped to treat patients on board with tissue plasminogen activator (tPA), with a vascular neurologist on board and the ability to do a CT scan and CT angiogram.

In the BEST-MSU study, mobile stroke units were deployed to 911 stroke calls for one week, and patients were treated on board or via telemedicine if they were deemed tPA-eligible. On alternating weeks, the units were not deployed, but staff met the EMS squad and determined whether the patient was tPA-eligible when they arrived on scene, so that the two arms included the same kinds of patients.

In the mobile stroke units, 33 percent of patients were treated during the first 60 minutes—the so-called “golden hour"—compared with just 3 percent of patients treated the standard way; in addition, 97.1 percent of those who were tPA-eligible received tPA in the mobile stroke unit group, compared to 79.1 percent of those in the standard treatment group. Most of that difference, Dr. Grotta said, was probably due to a greater inclination and willingness to use tPA by the mobile stroke unit vascular neurologist, compared to physicians in the ED.

Researchers used a utility-weighted modified Rankin score (uw-mRS), which takes into account patient perceptions about the levels of disability on the scale. For instance, an improvement from four to three—going from being unable to walk to being able to walk—is considered more significant than one to zero—non-significant symptoms versus no symptoms at all. At three months, there was a 0.07 difference in uw-mRS in favor of the mobile stroke unit group (p=0.002).

Based on these results, for every 100 patients treated with a mobile unit rather than standard management, 27 would have less final disability and 11 more will be disability-free, he said.

In the study, the units were used in fairly metropolitan areas, such as Los Angeles and Memphis, Dr. Grotta said, adding the value in rural areas remains to be seen.

Researchers will continue to assess health care utilization related to mobile stroke units for a year. But he said that if a mobile unit is active about half the time it treats 100 patients a year, resulting in 10 more patients completely recovering, that would likely more than cover the cost of the operating units.

“Even with a back-of-the-envelope calculation, I would predict that it's cost-effective to the health care system," he continued.

Commenting on the study, Robert J. Adams, MD, professor of neurology at the Medical University of South Carolina, said the data from this and other studies signal support for more frequent use of mobile stroke units.

“The data are consistent that earlier treatment leads to better outcomes, unless there are more hemorrhages," Dr. Adams told Neurology Today At the Meetings. “This study shows earlier treatment and a qualitative benefit, which is the ability for us to get experience in the 'golden hour.' We have very little data in that time domain. In my mind, these data—and I have been doing this since before there were stroke systems of care, prior to tPA and prior to the stroke certification effort—clearly provide a 'go' signal. These units should be part of the stroke treatment ecosystem."

Using the mobile stroke unit as a primary stroke center “surrogate" in an area with a high stroke rate but no hospital might be a way to increase its value, he said.

“The unit could be placed there more of the time and defer the community cost of building a facility primarily to treat stroke, for example," Dr. Adams said. “Another way to look at this would be for there to be a hefty surcharge to insurance carriers when the unit is used, to increase its ability to generate funds to defer its cost."

Dr. Grotta disclosed receiving a grant for research from Frazer Ltd and Genentech. Dr. Adams disclosed receiving consulting fees from Global Blood Products, a company that makes treatment for sickle cell disease. He has also received travel expenses from Zeriscope, Inc., a company that make mobile telemedicine platforms.

Link Up for More Information:​

ISC Abstract LB2: Grotta JC, Parker S, Bowry R, et al. Benefits of stroke treatment delivered by a mobile stroke unit compared to standard management by emergency medical services (BEST-MSU Study).