Mobile units speed acute stroke management
MedWire News: Use of an ambulance equipped with a mobile stroke unit (MSU) can half the delay between the emergency call and the therapy decision, shows a randomized trial.
"The MSU strategy offers a potential solution to the medical problem of the arrival of most stroke patients at the hospital too late for treatment… and substantially breaks, to our knowledge, all reported times [for] stroke management," said lead author Klaus Fassbender (University of the Saarland, Homburg, Germany) in a press statement.
The trial, which is published in The Lancet Neurology, included 100 patients who contacted the emergency services within 2.5 hours of stroke symptom onset. Rather than randomizing individual patients, the trial used a randomization pattern whereby all patients recruited in a specific week underwent diagnostic workup in the MSU and all those recruited the next week received all their care in hospital.
A total of 53 patients underwent treatment in the MSU, which was equipped with a computed tomography scanner, a point-of-care laboratory, and a telemedicine connection. These patients received a therapy decision a median of 35 minutes after alerting the emergency medical services.
By contrast, the 47 patients who received all their care in hospital had a median time of 76 minutes between the emergency call and the therapy decision, which was a significant 41 minutes longer.
Among patients eligible for thrombolysis, use of the MSU reduced the median time between symptom onset and treatment by 80 minutes, from 153 to 72 minutes.
However, there were no detectable differences between the groups in neurologic or functional outcomes at day 1 or day 7. For example, median National Institutes of Health Stroke Scale scores at day 7 were 2 and 4 in the MSU and hospital treatment groups, respectively. Safety endpoints, including intracranial hemorrhage, did not differ between the groups.
In an accompanying commentary, Peter Rothwell and Alastair Buchan (John Radcliffe Hospital, Oxford, UK) note that the open design of the trial makes the secondary clinical endpoints subject to bias, and that in any case, the trial was too small to allow reliable interpretation of clinical outcomes.
They add: "The MSU would potentially work less well in rural areas in which locally based ambulances might be able to get patients to hospital about as quickly as a hospital-situated MSU could get out to the patient. Nevertheless, this trial has shown convincingly that in at least some settings an MSU-based service is feasible and can substantially reduce delays to treatment."
By Eleanor McDermid