Study: Patients treated by mobile stroke units had better outcomes
A study published in the New England Journal of Medicine reported patients treated in a mobile stroke unit receive treatment faster and have lower mortality
HOUSTON — Ischemic stroke patients treated on a mobile stroke unit (MSU) received anti-clot medication faster and ended up with less disability at 90 days, according to a study published in the New England Journal of Medicine.
The study results, led by researchers at The University of Texas Health Science Center at Houston (UTHealth Houston) and Memorial Hermann-Texas Medical Center, revealed that patients treated on an MSU were more likely to receive the clot-busting drug tissue plasminogen activator (tPA), 97% compared to 80% with an EMS ambulance, and more likely to receive it in the first hour after a stroke. Mortality at 90 days was 9% for MSU versus 12% for EMS.
“The study revealed that for every 100 patients treated with an MSU rather than by standard ambulance, 27 will have less final disability and 11 more will be disability-free,” said James C. Grotta, MD, founder and director of the Houston Mobile Stroke Unit Consortium.
The study began in 2014 with the launch of the UTHealth Mobile Stroke Unit, the first MSU in the country, through a unique partnership with the Houston Fire Department and other local fire departments, as well as hospitals throughout the Texas Medical Center. The unique clinical trial compared outcomes for alternate weeks of service by the MSU or EMS.
“One of the things I am most proud of here in Houston is that an important study could be done that integrated the medical community and fire department,” said David Persse, MD, medical director of the Houston Fire Department-EMS. “That took a tremendous amount of integration and trust and one really important part was the Houston Mobile Stroke Unit Consortium.”
Mobile stroke units are special ambulances equipped with a computed tomography (CT) scanner and are staffed by personnel trained to diagnose and treat stroke patients in the prehospital setting, including paramedics, a CT technologist and a critical care nurse. A neurologist is available either onboard or via telemedicine.
“If mobile stroke units are more widely adopted, this could have a large impact on public health by changing the practice of prehospital care,” said Jose-Miguel Yamal, PhD, co-primary author and lead of the data coordinating center for the trial. “As we have learned in this trial, close integration and collaboration with the local emergency medical systems is integral to the success of mobile stroke units. Embedding mobile stroke units into the EMS system has a huge pay off by being able to treat more stroke patients in those first critical hours after stroke.”
Stephanie Parker, MHA, BSN, RN, manager of the UTHealth Mobile Stroke Unit Program, added: “Stroke affects an entire family, not just the patient. That’s why it’s so important to find ways to decrease a patient’s disability and improve their quality of life.”
The trial, which ran from 2014 to 2020 and enrolled more than 1,500 patients, eventually expanded across the country to include six additional sites: University of Tennessee in Memphis; New York Presbyterian (Weill Cornell and Columbia University); Indiana University Health; Sutter Health in Burlingame, California; University of California-Los Angeles; and University of Colorado-Anschutz Campus in Aurora and Colorado Springs, Colorado.
Initially, the UTHealth Mobile Stroke Unit carried a vascular neurology specialist on board, with Grotta; Ritvij Bowry, MD; and other UTHealth neurologists rotating the duty. A subsequent study published in 2017 showed that telemedicine could replace the neurologist on board the MSU, which lowered costs.
A comparison of health care resource utilization is currently being analyzed.
“More widespread deployment of mobile stroke units may have a major public health impact on reducing disability from stroke,” Grotta said. “Although mobile stroke units are costly to equip and staff, they reduce the time to treatment, and we expect that mobile stroke units will reduce the need for downstream utilization of long-term care.”
Article adapted from news release written by Deborah Mann Lake.