Mobile Stroke Units Superior to Standard Management in 90-Day Stroke Outcomes

James C. Grotta, MD

Results from the phase 3 BEST-MSU study (NCT02190500) demonstrate that treatment with mobile stroke units (MSUs) has greater success on disability and other stroke outcome measures compared to standard management (SM).^1,2

The data was presented virtually at the American Stroke Association’s (ASA) International Stroke Conference (ISC) 2021, March 17-19, by James C. Grotta, MD, director, stroke research, Clinical Institute for Research and Innovation, Memorial Hermann–Texas Medical Center. Grotta and colleagues used utility-weighted modified Rankin Scale (uw-mRS) scores at 3 months as the primary outcome. Among a cohort of 598 patients treated by MSU, the mean uw-mRS scores were 0.726 compared to 0.657 in patients treated with SM (P = .002).

The study authors concluded based on their findings that for every 100 patients treated with an MSU rather than SM, 27 more will have less final disability and 11 more will be disability-free, indicated by mRS scores of 0 or 1.

Providing patients with stroke with time-sensitive care, especially within the recommended 4-hour window, has been another benefit observed with MSUs. Injection of recombinant tissue plasminogen activator (tPA), otherwise known as alteplase, was administered to 33% of patients treated by MSU within 0 to 60 minutes from last known normal (LKN), compared to 3% of those on SM care.

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In total, 97.1% of tPA eligible patients were treated with tPA in less than 4.5 hours with MSUs compared to 79.1% in the SM group (chi-square test, P <.001). Furthermore, 88 patients (20.5%) did not receive treatment with tPA in the SM group, whereas only 18 (2.9%) did not in the MSU group.

Both MSU and SM had 33% of patients receive tPA bolus during the 61- to 90-minute window, but MSU had lower percentages in all of the following time points after (91-120 minutes, 121-180 minutes, and 180+ minutes).

The comparison of health resource utilization over the subsequent year will be published separately, according to the study authors.

"More widespread deployment of mobile stroke units may have a major public health impact on reducing disability from stroke,” Grotta said in a statement. “Although mobile stroke units are costly to equal the time to treatment. We expect that more treatment via mobile stroke units can reduce the need for downstream utilization of long-term care.”

MSUs observed in the study included a standard 12-foot ambulance, portable computed tomography (CT) scan, point-of-care laboratory, teleradiology and neurology, and a combination of a registered nurse (RN), vascular neurologist (VN), CT tech, and medic.

At ISC 2020, a study evaluating available MSUs revealed that functional outcomes for patients with acute ischemic stroke who are free from contraindications for thrombolysis and thrombectomy are significantly improved by these MSUs, compared to those who did not have that availability.

Grotta has been a proponent of implementing more widespread use of MSUs in the future care of stroke. He spoke with NeurologyLive in November 2020 and claimed that these innovations will be even more crucial as the medical world continues to navigate through the COVID-19 pandemic. Listen below to what he had to say.

For more coverage of ISC 2021, click here.

REFERENCES

1. Grotta JC, Parker S, Gonzalez NR, et al. Benefits of stroke treatment delivered by a mobile stroke unit compared to standard management by emergency medical services (BEST-MSU study). Presented at International Stroke Conference 2021; March 17–19. Abstract LB 2

2. Mobile stroke units improve outcomes and reduce disability among stroke patients. News release. American Stroke Association. March 17, 2021. Accessed March 17, 2021. https://newsroom.heart.org/news/mobile-stroke-units-improve-outcomes-and-reduce-disability-among-stroke-patients?preview=e2c2