Evidence continues to build for the benefits of mobile stroke units (MSU) but services considering their introduction should first optimise their existing pathways of care, experts say.
According to an editorial in the NEJM, the costs and effort required in implementing a MSU demands “proof that outcomes will be sufficiently better than those associated with existing systems.”
The editorial accompanied publication of the BEST-MSU study which found MSU management of acute ischaemic stroke in patients eligible to receive t-PA results in less disability at 90 days than standard management by emergency medical services (EMS).
The US study, which used an alternating week of care design, also found MSU management resulted in faster and more frequent t-PA treatment compared to EMS.
The prospective study, which enrolled 1,047 patients eligible for t-PA, found the mean score on the utility-weighted modified Rankin scale at 90 day was 0.72±0.35 in the MSU group and 0.66±0.36 in the EMS group.
“The primary analysis that used adjusted logistic regression for dichotomised 90-day scores on the utility-weighted modified Rankin scale of at least 0.91 or less than 0.91 (approximating a score on the modified Rankin scale of ≤1 or >1) resulted in a pooled odds ratio of 2.43 (95% CI, 1.75 to 3.36; P<0.001), favouring MSU in the models with or without inverse-probability weighting,” the study authors said.
In secondary outcomes, the median time from stroke onset to t-PA treatment was 72 minutes in the MSU group compared to 108 minutes in the EMS group.
A third (32.9%) of patients in the MSU group compared to 2.6% in the EMS group were treated within 60 minutes of symptoms onset.
“However, MSU management did not increase the frequency of or expedite EVT, although the time from arrival at an emergency department to the start of EVT was slightly shorter in the MSU group than in the EMS group.”