Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study

Kunz, Alexander; Ebinger, Martin; Geisler, Frederik; Różański, Michał; Waldschmidt, Carolin; Weber, Joachim E.; Wendt, Matthias; Winter, Benjamin; Zieschang, Katja; Fiebach, Jochen B.; Villringer, Kersten; Erdur, Hebun; Scheitz, Jan F.; Tütüncü, Serdar; Bollweg, Kerstin; Grittner, Ulrike; Kaczmarek, Sabina; Endres, Matthias; Nolte, Christian H.; Audebert, Heinrich J.

doi:10.1016/s1474-4422(16)30129-6

Cited by 121 publications

(125 citation statements)

References 25 publications

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“…The results from several studies indicate that the time from symptom onset to treatment with intravenous thrombolytic agents is significantly shorter compared with patients arriving by regular ambulance. 18,19 This strategy is only feasible in large urban centers where there are high volumes of patients and it is not an option for rural communities. In Canada, the first mobile stroke unit, located in Edmonton, Alberta, was launched in February 2017.…”

Section: Section 1: Organization Of Telestroke Services For Hyperacutmentioning

confidence: 99%

Canadian Stroke Best Practice Recommendations: Telestroke Best Practice Guidelines Update 2017

Blacquiere

Lindsay

Foley

et al. 2017

International Journal of Stroke

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Every year, approximately 62,000 people with stroke and transient ischemic attack are treated in Canadian hospitals. The 2016 update of the Canadian Stroke Best Practice Recommendations Telestroke guideline is a comprehensive summary of current evidence-based and consensus-based recommendations appropriate for use by all healthcare providers and system planners who organize and provide care to patients following stroke across a broad range of settings. These recommendations focus on the use of telemedicine technologies to rapidly identify and treat appropriate patients with acute thrombolytic therapies in hospitals without stroke specialized expertise; select patients who require to immediate transfer to stroke centers for Endovascular Therapy; and for the patients who remain in community hospitals to facilitate their care on a stroke unit and provide remote access to stroke prevention and rehabilitation services. While these latter areas of Telestroke application are newer, they are rapidly developing, with new opportunities that are yet unrealized. Virtual rehabilitation therapies offer patients the opportunity to participate in rehabilitation therapies, supervised by physical and occupational therapists. While not without its limitations (e.g., access to telecommunications in remote areas, fragmentation of care), the evidence-to-date sets the foundation for improving access to care and management for patients during both the acute phase and now through post stroke recovery.

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Section: Section 1: Organization Of Telestroke Services For Hyperacutmentioning

confidence: 99%

Canadian Stroke Best Practice Recommendations: Telestroke Best Practice Guidelines Update 2017

Blacquiere

Lindsay

Foley

et al. 2017

International Journal of Stroke

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“…Mobile stroke units have shown an ability to treat patients rapidly, with median alarmto-treatment times more than 20 to 30 min faster than standard hospital treatment [2][3][4]. While our MSU could be more optimally stationed to meet the needs of high-burden patients, we have established a number of strategies to ensure rapid scene arrival to IVtPA treatment times.…”

Section: Discussionmentioning

confidence: 99%

“…Mobile stroke units (MSU) compared to standard emergency care have achieved ultra-early treatment of acute ischemic stroke [2][3][4]. However, the geospatial distribution of actual stroke cases around an MSU hub has yet to be explored, and this factor holds potential to direct location of future units, thereby shortening tPA treatment times.…”

mentioning

confidence: 99%

Geospatial Visualization of Mobile Stroke Unit Dispatches: A Method to Optimize Service Performance

et al. 2018

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Background: Timely treatment of acute ischemic stroke is crucial to optimize outcomes. Mobile stroke units (MSU) have demonstrated ultrafast treatment compared to standard emergency care. Geospatial analysis of the distribution of MSU cases to optimize service delivery has not been reported. Methods: We aggregated all first-year MSU dispatch occurrences and all cases classified by clinical teams as true stroke by zip code and calculated dispatch and true stroke incidence rates. We mapped dispatch and stroke cases and symbolized incidence rates by standard deviation. We confirmed visual impressions of clusters from map inspection by local Moran’s I, boxplot inspection, and t test. We calculated service areas using drive times to meet dispatch and true stroke need. Results: A significant cluster of high dispatch incident rate was confirmed around our MSU base in urban Memphis within a 5-min driving area supporting the initial placement of the MSU based on 911 activation. A significant cluster of high true stroke rate was confirmed to the east of our MSU base in suburban Memphis within a 10-min driving area. Mean incident longitude of cases of true stroke versus disregarded status was significantly eastward (p = 0.001785). Conclusion: Our findings will facilitate determination of socio-spatial antecedents of neighborhood overutilization of 911 and MSU services in our urban neighborhoods and service delivery optimization to reach neighborhoods with true stroke burden.

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“…18 Theoretically, the reduction in time to treatment enabled by the implementation of MSUs should translate to better clinical outcomes, but studies have shown that patient survival and disability at 3 months after the cerebrovascular incident remain unchanged. 22 Despite several promising pilot studies, the concept of the MSU has yet to be widely adopted due to the high startup and maintenance costs (of both the equipment and the core MSU team that consists of a paramedic and a stroke physician), radiation safety protocols, special licensure, and lack of data on the cost effectiveness of this approach.…”

Section: Mobile Stroke Unitsmentioning

confidence: 99%

Expanding the treatment window for ischemic stroke through the application of novel system-based technology

El‐Ghanem¹,

Al‐Mufti²,

Thulasi

et al. 2017

FOC

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Recent randomized controlled trials have demonstrated the superiority of endovascular treatment (ET) over medical management in the treatment of acute ischemic stroke patients with anterior circulation emergent large vessel occlusions (ELVOs). Due to such accumulating evidence, expanding ET has become of paramount importance. Advancements in modern technology have enabled the use of mobile stroke units, telestroke networks, mobile neuroendovascular teams, and smartphone applications that shorten the time window to treatment and, thus, make patients more amenable to ET. Additionally, modifying stroke-screening tools to make them more accessible to first responders and the creation of stroke registries can provide further opportunities for ET.

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Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study

Cited by 121 publications

References 25 publications

Canadian Stroke Best Practice Recommendations: Telestroke Best Practice Guidelines Update 2017

Canadian Stroke Best Practice Recommendations: Telestroke Best Practice Guidelines Update 2017

Geospatial Visualization of Mobile Stroke Unit Dispatches: A Method to Optimize Service Performance

Expanding the treatment window for ischemic stroke through the application of novel system-based technology

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