Diurnal Variations in the First 24/7 Mobile Stroke Unit

Zaidat, Osama O.; Changal, Khalid; Sultan-Qurraie, Ali; Havenon, Adam de; Calderon, Victoria J.; Goins-Whitmore, Julie; Patterson, Mary S.; Lin, Eugene C.

doi:10.1161/strokeaha.119.024950

Cited by 9 publications

(18 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The operational hours were designed to capture approximately 64% of all suspected stroke dispatches within the 20-kilometre primary co-dispatch radius, whilst simultaneously being able to be broken into two 5 h morning and afternoon shifts. The estimated workload appears to be consistent with the experience of the first 24 h MSU based in Toledo, USA where the vast majority of dispatches occurred from 7AM-7PM and the bulk of the thrombolysis cases occurred between approximately 10AM-6PM [6] .…”

Section: Operationalization Of the Melbourne Mobile Stroke Unitsupporting

confidence: 74%

Advances in pre-hospital care - operational experiences from the Melbourne mobile stroke unit

Zhao¹,

Campbell²,

Foster³

et al. 2021

View full text Add to dashboard Cite

Mobile stroke units (MSU) are specially designed ambulances with CT imaging capability able to provide faster pre-hospital care to patients in the community. The Melbourne Mobile Stroke Unit is the first MSU service in the Australian region, commencing operations in 2017 in central metropolitan Melbourne. This review describes the challenges of setting up the MSU in a unique Australian setting and initial clinical efficacy of pre-hospital MSU treatment and triage on ischemic and hemorrhagic stroke. We also discuss the current technological and operational limitations of the MSU service and directions for future research.

show abstract

Section: Operationalization Of the Melbourne Mobile Stroke Unitsupporting

confidence: 74%

Advances in pre-hospital care - operational experiences from the Melbourne mobile stroke unit

Zhao¹,

Campbell²,

Foster³

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The pooled average rate was 2.0% (95% CI 1.2–2.8%). Eleven studies reported information regarding rates of tPA administration based on time of MSU availability ( 4 , 5 , 8 , 9 , 13 – 16 , 18 , 20 , 21 ). Collectively, tPA was administered 1,858 times over 4,961 available days (defined as 24-h period), for a rate of 0.358 (95% CI 0.215–0.502) ( Figure 3 ).…”

Section: Resultsmentioning

confidence: 99%

Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis

et al. 2022

View full text Add to dashboard Cite

BackgroundThe available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to establish normalized metrics and to conduct a meta-analysis of the current literature on MSU performance.MethodsOur MSU in upstate New York serves 741,000 people. We present prospectively collected, retrospectively analyzed data from the inception of our MSU in October of 2018, through March of 2021. Rates of transportation/dispatch and MSU utilization were reported. We also performed a meta-analysis using MEDLINE, SCOPUS, and Cochrane Library databases, calculating rates of tPA/dispatch, tPA-per-24-operational-hours (“per day”), mechanical thrombectomy (MT)/dispatch and MT/day.ResultsOur MSU was dispatched 1,719 times in 606 days (8.5 dispatches/24-operational-hours) and transported 324 patients (18.8%) to the hospital. Intravenous tPA was administered in 64 patients (3.7% of dispatches) and the rate of tPA/day was 0.317 (95% CI 0.150–0.567). MT was performed in 24 patients (1.4% of dispatches) for a MT/day rate of 0.119 (95% CI 0.074–0.163). The MSU was in use for 38,742 minutes out of 290,760 total available minutes (13.3% utilization rate). Our meta-analysis included 14 articles. Eight studies were included in the analysis of tPA/dispatch (342/5,862) for a rate of 7.2% (95% CI 4.8–9.5%, I2 = 92%) and 11 were included in the analysis of tPA/day (1,858/4,961) for a rate of 0.358 (95% CI 0.215–0.502, I2 = 99%). Seven studies were included for MT/dispatch (102/5,335) for a rate of 2.0% (95% CI 1.2–2.8%, I2 = 67%) and MT/day (103/1,249) for a rate of 0.092 (95% CI 0.046–0.138, I2 = 91%).ConclusionsIn this single institution retrospective study and meta-analysis, we outline the following operational metrics: tPA/dispatch, tPA/day, MT/dispatch, MT/day, and utilization rate. These metrics are useful for internal and external comparison for institutions with or considering developing mobile stroke programs.

show abstract

“…While mobile stroke units gain increasing popularity, concerns regarding its cost‐effectiveness and wide‐scale implementation remain. Zaidat et al 15 demonstrated that 91% of intravenous tissue plasminogen activator administrations on the mobile stroke unit occurred between the hours of 7:00 am and 11:00 pm . The RACE score and other prehospital stroke triage tools may effectively complement mobile stroke units at night and allow for early, accurate identification and treatment of LVO.…”

Section: Discussionmentioning

confidence: 99%

Performance of the RACE Prehospital Triage Score During Working and Nonworking Hours

Salahuddin

Castonguay

Hitomi

et al. 2021

SVIN

View full text Add to dashboard Cite

Background Prehospital triage scores aim to identify large vessel occlusions (LVOs) in the field; however, their real‐world performance and accuracy across a 24‐hour period remains unknown. In this study, we compare the positive predictive value of the prehospital Rapid Arterial occlusion Evaluation (RACE) score for the detection of LVO during working hours and nonworking hours. Methods We performed a retrospective review of all patients presenting with a RACE score of ≥5 at one comprehensive and one thrombectomy‐capable hospital between July 2015 and December 2019. Patients were dichotomized to those presenting during “working hours” (7:00 am to 6:00 pm on weekdays) or “nonworking hours” (6:01 pm to 6:59 am on weekdays or anytime during weekends). The primary outcome was diagnosis of LVO. Secondary outcomes included diagnosis of acute neurovascular syndromes, door‐to‐treatment time metrics, and a modified Rankin Scale of ≤2 in those undergoing mechanical thrombectomy. Results Of the 701 patients with RACE score ≥5, 687 patients were included (355 nonworking hours and 332 working‐hours cohorts). Mean age was 71 and 72 years in the nonworking hours and working hours groups, respectively ( P =0.13). Median National Institutes of Health Stroke Scale and baseline demographics were comparable between the 2 groups. There was no significant difference in the diagnosis of LVO (36.3% versus 34.6%; P =0.69) or final discharge diagnosis. The positive predictive value of the RACE score for the detection of an acute neurovascular syndrome (transient ischemic attack and stroke) was improved during nonworking hours (76.3% versus 67.8%; P =0.01). In patients undergoing mechanical thrombectomy, rates of good clinical outcome were similar (44.7% versus 48%; P =0.76), despite the shorter door‐to‐groin‐puncture and revascularization times during working hours. Conclusions The RACE score shows a consistent positive predictive value in determining LVO during working and nonworking hours. However, it is more accurate in determining acute neurovascular syndromes during nonworking hours, which is driven by a decrease in stroke mimics during this time.

show abstract

Diurnal Variations in the First 24/7 Mobile Stroke Unit

Cited by 9 publications

References 8 publications

Advances in pre-hospital care - operational experiences from the Melbourne mobile stroke unit

Advances in pre-hospital care - operational experiences from the Melbourne mobile stroke unit

Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis

Performance of the RACE Prehospital Triage Score During Working and Nonworking Hours

Contact Info

Product

Resources

About