Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond

Faßbender, Klaus; Phillips, Daniel J.; Grunwald, Iris Q.; Schottek, Andrea; Alam, Sajid; Perera, Saman; Chakrabarti, Annie; Moon, Robert; Lesmeister, Martin; Wagner, Viola; Wheddon, Damon; Dommett, David; Wells, Brittany; Middleton, Rheanne; Willis, Robert J.; Bachhuber, Monika; Merzou, Fatma; Wagenpfeil, Stefan; Thottath, Jineesh; Bertsch, Thomas; Walter, Silke

doi:10.1161/svin.122.000482

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…The estimated proportions of patients with ischemic stroke, transient ischemic attack (TIA), hemorrhagic stroke, and stroke mimics typically treated by MSU were taken from recent literature ( 9 , 10 ). MSU-specific metrics such as the number of cancelations, utilization rate, average distance and duration per dispatch, as well as the tPA administration rate were considered ( 11 , 12 ).…”

Section: Methodsmentioning

confidence: 99%

Establishing an MSU service in a medium-sized German urban area—clinical and economic considerations

Rink,

Tollens,

Tschalzev

et al. 2024

Front. Neurol.

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Background and purposeMobile stroke units (MSU) have been demonstrated to improve prehospital stroke care in metropolitan and rural regions. Due to geographical, social and structural idiosyncrasies of the German city of Mannheim, concepts of established MSU services are not directly applicable to the Mannheim initiative. The aim of the present analysis was to identify major determinants that need to be considered when initially setting up a local MSU service.MethodsLocal stroke statistics from 2015 to 2021 were analyzed and circadian distribution of strokes and local incidence rates were calculated. MSU patient numbers and total program costs were estimated for varying operating modes, daytime coverage models, staffing configurations which included several resource sharing models with the hospital. Additional case-number simulations for expanded catchment areas were performed.ResultsMedian time of symptom onset of ischemic stroke patients was 1:00 p.m. 54.3% of all stroke patients were admitted during a 10-h time window on weekdays. Assuming that MSU is able to reach 53% of stroke patients, the average expected number of ischemic stroke patients admitted to MSU would be 0.64 in a 10-h shift each day, which could potentially be increased by expanding the MSU catchment area. Total estimated MSU costs amounted to € 815,087 per annum. Teleneurological assessment reduced overall costs by 11.7%.ConclusionThis analysis provides a framework of determinants and considerations to be addressed during the design process of a novel MSU program in order to balance stroke care improvements with the sustainable use of scarce resources.

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Section: Methodsmentioning

confidence: 99%

Establishing an MSU service in a medium-sized German urban area—clinical and economic considerations

Rink,

Tollens,

Tschalzev

et al. 2024

Front. Neurol.

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“…Specifically for this reason, a ‘Hybrid-MSU’, an MSU with extended capabilities (radiography, ultrasonography, refined POC laboratory, electrocardiography, electroencephalography and advanced medications and so on), has been tested. Results suggest that mainly cerebral conditions other than stroke, such as traumatic brain injury, subarachnoid haemorrhage and status epilepticus, may also profit from diagnosis, accurate triage decision-making and treatment directly at the emergency site [45].…”

Section: Future Directions and Conclusionmentioning

confidence: 99%

Prehospital stroke management and mobile stroke units

Faßbender

Lesmeister

Merzou

2023

Current Opinion in Neurology

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Purpose of reviewDelayed presentation at the hospital contributes to poorer patient outcomes and undertreatment of acute stroke patients. This review will discuss recent developments in prehospital stroke management and mobile stroke units aimed to improve timely access to treatment within the past 2 years and will point towards future directions.Recent findingsRecent progress in research into prehospital stroke management and mobile stroke units ranges from interventions aimed at improving patients’ help-seeking behaviour, to the education of emergency medical services team members, to the use of innovative referral methods, such as diagnostic scales, and finally to evidence of improved outcomes by the use of mobile stroke units.SummaryUnderstanding is increasing about the need for optimizing stroke management over the entire stroke rescue chain with the goal of improving access to highly effective time-sensitive treatment. In the future, we can expect that novel digital technologies and artificial intelligence will become relevant in effective interaction between prehospital and in-hospital stroke-treating teams, with beneficial effects on patients’ outcomes.

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Mobile stroke units services in Germany: A cost‐effectiveness modeling perspective on catchment zones, operating modes, and staffing

Rink,

Szabo,

Hoyer

et al. 2024

Euro J of Neurology

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Background and PurposeInvestigating the cost‐effectiveness of future mobile stroke unit (MSU) services with respect to local idiosyncrasies is essential for enabling large‐scale implementation of MSU services. The aim of this study was to assess the cost‐effectiveness for varying urban German settings and modes of operation.MethodsCosts of different operating times together with different personnel configurations were simulated. Different possible catchment zones, ischemic stroke incidence, circadian distribution, rates of alternative diagnoses, as well as missed cases were incorporated to model case coverage and patient numbers. Based on internationally reported clinical outcomes of MSUs, a 5‐year Markov model was applied to analyze the cost‐effectiveness for the different program setups.ResultsCompared with standard stroke care, MSUs achieved an additional 0.06 quality‐adjusted life years (QALYs) over a 5‐year time horizon. Assuming a catchment zone of 750,000 inhabitants and 8 h/7 day operation resulted in an incremental cost‐effectiveness ratio (ICER) of €37,182 per QALY from a societal perspective and €45,104 per QALY from a healthcare perspective. Lower ICERs were possible when coverage was expanded to 16 h service on 7 days per week and larger populations. Sensitivity analyses revealed that missing ischemic strokes significantly deteriorated economic performance of MSU.ConclusionsMajor determinants of cost‐effectiveness should be addressed when setting up novel MSU programs. Catchment zones of more than 500,000–700,000 inhabitants and operating times of at least 12–16 h per day, 7 days per week could enable the most cost‐effective MSU services in the German healthcare system.

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Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond

Cited by 3 publications

References 16 publications

Establishing an MSU service in a medium-sized German urban area—clinical and economic considerations

Establishing an MSU service in a medium-sized German urban area—clinical and economic considerations

Prehospital stroke management and mobile stroke units

Mobile stroke units services in Germany: A cost‐effectiveness modeling perspective on catchment zones, operating modes, and staffing

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