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Effect of mobile stroke unit dispatch in all patients with acute stroke or TIA

Ann Neurol. 2022 Oct 30. doi: 10.1002/ana.26541. Online ahead of print.


OBJECTIVE: To determine the effect of additional mobile stroke unit (MSU) dispatch on functional outcomes among the full spectrum of stroke patients, regardless of subtype or potential reperfusion therapies contraindications.

METHODS: We used data from the nonrandomized Berlin-based B_PROUD study (02/2017-05/2019), in which MSUs were dispatched based solely on availability, and the linked B-SPATIAL stroke registry. All patients with final stroke or transient ischemic attack (TIA) diagnosis were eligible. The intervention under study was the additional dispatch of an MSU, an emergency physician-staffed ambulance equipped to provide prehospital imaging and thrombolytic treatment, compared to conventional ambulance alone. The primary outcome was the 3-month modified Rankin Scale (mRS) score, and the co-primary outcome was a 3-tiered disability scale. We identified confounders using Directed Acyclic Graphs and obtained adjusted effect estimates using inverse probability of treatment weighting.

RESULTS: MSUs were dispatched to 1,125 patients (mean age: 74y, 46.5% female), while for 1,141 only conventional ambulances were dispatched (75y, 49.9% female). After confounding adjustment, MSU dispatch was associated with more favorable 3-month mRS scores (common odds ratio, cOR=0.82; 95%CI: 0.71-0.94). No statistically significant association was found with the co-primary outcome (cOR=0.86; 0.72-1.01) or seven-day mortality (OR=0.94; 0.59-1.48).

INTERPRETATION: When considering the entire population of stroke/TIA patients, MSU dispatch improved 3-month functional outcomes without evidence of compromised safety. Our results are relevant for decision-makers since stroke subtype and treatment eligibility are unknown at time of dispatch. This article is protected by copyright. All rights reserved.

PMID:36309933 | DOI:10.1002/ana.26541

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