Background: The efficacy of mobile stroke units (MSU) in improving acute ischemic stroke (AIS) care in developing countries is unknown. We compared performance measures and treatment outcomes between MSU and usual care. Methods: We enrolled patients >18 years of age with a diagnosis of AIS who presented with onset to door < 4.5 hours and stroke code was alert either at the Siriraj MSU (SiMSU) or at the emergency department (ED). The same AIS treatment guideline for intravenous tPA or endovascular treatment (EVT) were applied in both groups. Demographic data, type(s) of reperfusion therapy (tPA and/ or EVT) were recorded. Stroke onset to door (OD), door to CT (DCT), door to needle (DN), and door to puncture (DP) time were collected. Stroke outcome was measured by the modified Rankin Score (mRS) at 3 months. Results: A total of 519 AIS patients (130 from SiMSU and 389 from ED) were enrolled between June 2018 and December 2019. The mean age ( + SD) was 66 ( + 13.9), 254 (48.9%) were male. AIS key process time measures were significantly shorter in the SiMSU with a mean + SD DCT time of 7 + 4.9 vs 16 + 13.7 minutes (p< 0.01), DN time of 21 + 7 vs 34 + 13.8 minutes (p< 0.01) and DP time of 71 + 20 vs 94 + 44.6 minutes, (p<0.01) in SiMSU and ED respectively. Although EVT rate was similar, intravenous tPA rate was significantly higher in SiMSU 59.2% vs 34.4% (p< 0.01). The mRS of 0-2 at 3 months was significantly higher in SiMSU than the ED (67.5% vs 57.9%, p=0.01). Conclusions: The SiMSU significantly shortened door to reperfusion treatment, increased access to IV t-PA and improved stroke outcomes by reducing disability at 3 months when compare to standard of care (i.e. ED arrival). This working paradigm could be implemented in other similar healthcare settings to improved AIS care.

Background The efficacy of mobile stroke units (MSUs) in improving acute ischemic stroke (AIS) care in developing countries is unknown. We compared performance measures and stroke outcomes in AIS patients between MSU and usual care: emergency medical services (EMS) and walk-in. Methods We enrolled patients > 18 years of age with an AIS within 4.5 h after onset. Demographic data, types, and time of reperfusion therapies and clinical outcomes were recorded. A favorable outcome was defined as a modified Rankin Scale (mRS) 0–2 at 3 months. Results A total of 978 AIS patients (MSU = 243, EMS = 214, walk-in = 521) were enrolled between June 1, 2018, and April 30, 2021. The mean age (± SD) was 66 (± 14) years, and 510 (52.1%) were male. AIS time metrics were the shortest in the MSU with a mean (± SD) door to needle (DN) time of 20 (± 7), 29 (± 13), and 35 (± 16) min (p < 0.001) and door to puncture (DP) time of 73 ± 19, 86 ± 33, and 101 ± 42 min (p < 0.001) in MSU, EMS, and walk-in, respectively. Participants in the MSU (56.8%) received higher rate of reperfusion therapie(s) when compared to the EMS (51.4%) and walk-in (31.5%) (p < 0.001). After adjustment for any potential confounders and using the EMS as a reference, the MSU has the highest likelihood of achieving a favorable outcome (adjusted OR 2.15; 95% CI 1.39–3.32). Conclusions In underserved populations, MSUs significantly reduced DN time, increased the likelihood of receiving reperfusion treatment, and achieved independency at 3 months when compared to usual care.

Background and Purpose: A simple and reliable prediction of post intravenous recombination tissue plasminogen activator (rt-PA) intracerebral hemorrhage (ICH) is useful for stroke team to inform individual risk and improve hospitalization care. We aim to develop and validate a simple predictive score model to assess the 24-hour risk of ICH post rt-PA. Methods: This retrospective study included 739 acute ischemic stroke patients who received intravenous rt-PA between October 2005 and June 2020 at Siriraj Hospital, Bangkok, Thailand. Multiple logistic regression was used to evaluate the value of independent variables associated with any ICH and symptomatic intracerebral hemorrhage (SICH) measure by the European Cooperative Acute Stroke Study II (ECASS II) definition. Adjusted ORs of independent variables were converted to point score, summated of point score provide a probability of ICH and SICH. The predictive scores were internal validated in 95 patients and performance tested with an area under a receiver operating characteristic curve (AUC-ROC). Results: From a total of 739 patients, 19.2% had an ICH in which 5.9% was SICH. The predictive model of ICH included hyperdense middle cerebral artery sign (HDMCA) (3 points), initial blood glucose > 180mg/dl (3 points), coronary artery disease (CAD) (2 points), international normalized ratio (INR) > 1.0 (2 points) and 10 year increase of age ( 1 point per 10 year increase; age ≤ 20 year = 1). The performance of the predictive model showed AUC-ROC was 0.72 (95% confidence interval, 0.60 - 0.82) in the derivative cohort and AUC-ROC was 0.74 (95% confidence interval, 0.66 - 0.85) in the validation cohort. Conclusions: This simple predictive model provides a better prediction of a 24-hour risk of ICH post rt-PA in AIS among Thai patients. An individualized ICH risk post rt-PA can assist frontline physicians and relatives in rt-PA decision making process. Further external validation and prospectively confirmed in a larger cohort is recommend.

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