Prehospital management in a mobile stroke unit vs standard emergency medical services (EMS) management is associated with more favorable global disability levels(NOT AN ACCEPTABLE GOAL!) at discharge following acute ischemic stroke, according to study findings published in JAMA Neurology.

Researchers conducted a retrospective, observational, cohort study to determine the relationship between prehospital management in a mobile stroke unit vs standard EMS management and global disability at discharge post-acute ischemic stroke. Data were sourced from the American Heart Association’s Get With The Guidelines-Stroke Program. Individuals with an ischemic stroke diagnosis who were potentially eligible for intravenous (IV) thrombolysis who received prehospital management in a mobile stroke unit or standard EMS management between August 2018 and January 2023 were eligible for inclusion. The primary outcome was the level of global disability at discharged, which was measured using the utility-weighted modified Rankin Scale (mRS). Logistic regression and generalized linear mixed models were used in statistical analyses.

A total of 19,433 patients (median age, 73; women, 50.8%; White, 53.5%) with ischemic stroke were included in the study, of whom 1237 (6.4%) received prehospital management in a mobile stroke unit and 18,196 (93.6%) received standard EMS management.

These findings support efforts to expand access to prehospital MSU [mobile stroke unit] management.

Recipients of prehospital management in a mobile stroke unit vs standard EMS management had higher utility-weighted mRS scores (adjusted mean difference [aMD], 0.03; 95% CI, 0.01-0.05), rates of independent ambulation at discharge (adjusted risk ratio [aRR], 1.08; 95% CI, 1.03-1.13), rates of nondisabled outcome at discharge (mRS, 0-1), and functional independence at discharge (mRS, 0-2).

No between-group differences were observed for the following safety endpoints:

  • In-hospital mortality: aRR, 1.03; 95% CI, 0.78-1.27;
  • In-hospital mortality in combination with discharge to hospice: aRR, 0.99; 95% CI, 0.87-1.15;
  • Symptomatic intracranial hemorrhage: aRR, 1.30; 95% CI, 0.94-1.75; and,
  • Length of stay: aMD, 0.07; 95% CI, -0.21 to 0.44.

Patients potentially eligible for IV thrombolysis were more likely to receive IV thrombolysis when they received prehospital management in a mobile stroke unit vs standard EMS management (aRR, 1.26; 95% CI, 1.22-1.29).

Among patients diagnosed with ischemic stroke, those who received prehospital management in a mobile stroke unit vs standard EMS management demonstrated a higher utility-weighted mRS score (aMD, 0.04; 95% CI, 0.03-0.05), were more likely to be ambulatory at discharge (aRR, 1.14; 95% CI, 1.11-1.18), and exhibited a lower risk for in-hospital death (aRR, 0.85; 95% CI, 0.71-0.97).

Of patients who were diagnosed with ischemic stroke, hemorrhagic stroke, or no stroke-related diagnosis, those who received prehospital management in a mobile stroke unit vs standard EMS management demonstrated a higher utility-weight mRS (aMD, 0.05l 95% CI, 0.03-0.06).

Study limitations included potential residual confounding, reduced generalizability of results to a more diverse sample population, lack of data regarding the mode of neurologic assessment during prehospital mobile stroke unit management, and conservative bias.

“These findings support efforts to expand access to prehospital MSU [mobile stroke unit] management,” the study authors concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.