scholarly journals The mobile stroke unit and management of acute stroke in rural settings

2018 ◽  
Vol 190 (28) ◽  
pp. E855-E858 ◽  
Author(s):  
Ashfaq Shuaib ◽  
Thomas Jeerakathil
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Mobile Stroke Unit ◽  
Rural Settings

Retrospective Review and Proof of Concept of Asia’s First Mobile Stroke Unit Experience in Kovai Medical Center and Hospital

2020 ◽  
Vol 3 (2) ◽  
pp. 116-123
Author(s):  
Mathew Cherian ◽  
Pankaj Mehta ◽  
Shriram Varadharajan ◽  
Santosh Poyyamozhi ◽  
Elango Swamiappan ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Retrospective Review ◽  
Stroke Unit ◽  
Care Pathway ◽  
Clinical Care ◽  
Stroke Care ◽  
First Year ◽  
Proof Of Concept ◽  
Mobile Stroke Unit ◽  
Clinical Care Pathway

Background: We review our initial experience of India’s and Asia’s first mobile stroke unit (MSU) following the completion of its first year of operation. We outline the clinical care pathway integrating the MSU services using a case example taking readers along our clinical care workflow while highlighting the challenges faced in organizing and optimizing such services in India. Methods: Retrospective review of data collected for all patients from March 2018 to February 2019 transported and treated within the MSU during the first year of its operation. Recent case example is reviewed highlighting complete comprehensive acute clinical care pathway from prehospital MSU services to advanced endovascular treatment with focus on challenges faced in developing nation for stroke care. Results: The MSU was dispatched and utilized for 14 patients with clinical symptoms of acute stroke. These patients were predominantly males (64%) with median age of 59 years. Ischemic stroke was seen in 7 patients, hemorrhagic in 6, and 1 patient was classified as stroke mimic. Intravenous tissue plasminogen activator was administered to 3 patients within MSU. Most of the patients’ treatment was initiated within 2 h of symptom onset and with the median time of patient contact (rendezvous) following stroke being 55 mins. Conclusion: Retrospective review of Asia’s first MSU reveals its proof of concept in India. Although the number of patients availing treatment in MSU is low as compared to elsewhere in the world, increased public awareness with active government support including subsidizing treatment costs could accelerate development of optimal prehospital acute stroke care policy in India.

scholarly journals Mobile Stroke Unit in the UK Healthcare System: Avoidance of Unnecessary Accident and Emergency Admissions

2020 ◽  
Vol 49 (4) ◽  
pp. 388-395
Author(s):  
Iris Q. Grunwald ◽  
Daniel J. Phillips ◽  
David Sexby ◽  
Viola Wagner ◽  
Martin Lesmeister ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Hospital Admissions ◽  
Hospital Treatment ◽  
Stroke Patients ◽  
Transient Ischaemic Attacks ◽  
Accident And Emergency ◽  
Mobile Stroke Unit ◽  
The Uk

Background: Acute stroke patients are usually transported to the nearest hospital regardless of their required level of care. This can lead to increased pressure on emergency departments and treatment delay. Objective: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions. Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service area in Southend-on-Sea was conducted. Emergency patients categorized as code stroke and headache were included from June 5, 2018, to December 18, 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward, and stroke management metrics were assessed. Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to 8 of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, 1 patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 min (interquartile range, 40–60). Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments.

Abstract TP282: Prehospital Acute Stroke Treatment by Critical Care Physicians in a Mobile Stroke Unit

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Karianne Larsen ◽  
Lars H Tveit ◽  
Henriette S Jæger ◽  
Maren R Hov ◽  
Jo Røislien ◽  
...  
Keyword(s):  
Critical Care ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Stroke Treatment ◽  
Mobile Stroke Unit ◽  
Acute Stroke Treatment

scholarly journals Building a Mobile Stroke Unit Based on 5G Technology – A Study Protocol

2021 ◽  
Vol 12 ◽  
Author(s):  
Gangfeng Gu ◽  
Junyao Jiang ◽  
Bo Zheng ◽  
Xiao Du ◽  
Ke Huang ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Mobile Networks ◽  
Stroke Unit ◽  
Controlled Trial ◽  
Treatment Decision ◽  
Decision Time ◽  
Clinical Trial Registration ◽  
Regular Care ◽  
Mobile Stroke Unit

Background: In-time treatment of acute stroke is critical to saving people’s lives and improving the quality of post-stroke life. A mobile stroke unit (MSU) with fifth-generation (5G) mobile networks strengthens the interaction of patient information and healthcare resources, thereby reducing response times and improving thrombolysis results. However, clinical evidence of better outcomes compared to regular care is still lacking.Method and Design: In this randomized controlled trial, 484 patients with acute stroke are allocated into the MSU and regular care groups. We establish medical records for each patient and conduct a follow-up of 90 days. The primary outcomes are functional results as defined by utility-weighted modified Rankin Scale (uw-mRS) 90 days after the incidence occurred, whereas secondary outcomes include the alarm to CT scan completed time, the alarm to treatment decision time, the alarm to thrombolytic time, quality of life, and symptomatic intracranial hemorrhage combined with NIHSS score as well as cost-effectiveness.Discussion: This study establishes an innovative MSU (based on 5G) to manage acute stroke, comparing its clinical and economic outcomes to regular care and informing decision-makers of the effectiveness of the stroke emergency system.Clinical Trial Registration: [http://www.chictr.org.cn/showproj.aspx?proj=63874], identifier [ChiCTR2000039695].

scholarly journals Pre-hospital triage of suspected acute stroke patients in a mobile stroke unit in the rural Alberta

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mahesh P. Kate ◽  
Thomas Jeerakathil ◽  
Brian H. Buck ◽  
Khurshid Khan ◽  
Ali Zohair Nomani ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Hospital Care ◽  
Tertiary Care ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Tertiary Care Centre ◽  
Local Hospital ◽  
Medical Needs ◽  
Mobile Stroke Unit

AbstractMobile Stroke Unit (MSU) expedites the delivery of intravenous thrombolysis in acute stroke patients. We further evaluated the functional outcome of patients shipped to a tertiary care centre or repatriated to local hospitals after triage by MSU in acute stroke syndrome in rural northern Alberta. Consecutive patients with suspected acute stroke syndrome were included. On the basis of neurology consultation and, Computed Tomography findings, patients, who were thrombolysed or needed advanced care were transported to the Comprehensive stroke center (CSC) (Triage to CSC group). Other patients were repatriated to local hospital care (Triage to LHC group). A total of 156 patients were assessed in MSU, 73 (46.8%) were female and the mean age was 66.6 ± 15 years. One hundred and eight (69.2%) patients, including 41 (26.3%) treated with thrombolysis were transported to the CSC (Triage to CSC group) and 48 (30.8%) were repatriated to local hospital care. The diagnosis made in MSU and final diagnosis were matching in 88% (95) and 91.7% (44, p = 0.39) in Triage to CSC and Triage to LHC groups respectively. Prehospital triage by MSU of acute stroke syndrome can reliably repatriate patients to the home hospital. The proposed model has the potential to triage patients according to their medical needs by enabling treatment in home hospitals whenever reasonable.

Mobile stroke unit versus standard medical care in the management of patients with acute stroke: A systematic review and meta-analysis

2020 ◽  
Vol 15 (6) ◽  
pp. 595-608 ◽  
Author(s):  
Nida Fatima ◽  
Maher Saqqur ◽  
M Shazam Hussain ◽  
Ashfaq Shuaib
Keyword(s):  
Clinical Outcome ◽  
Confidence Interval ◽  
Acute Stroke ◽  
Odds Ratio ◽  
Stroke Unit ◽  
Conventional Care ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Mobile Stroke Unit ◽  
The Mean

Introduction Mobile stroke units have recently been introduced in the care of patients suspected of having an acute stroke, leading to shortening in the time to thrombolytics. We aimed to compare the clinical effectiveness in terms of functional outcome and survival among patients treated in mobile stroke unit and/or conventional care. Methods A systematic search of electronic databases, comparing the clinical outcomes among patients with acute stroke in the same study was conducted from 1990 to 2019. Pooled and subgroup analysis were performed using the random- and fixed-effect model based upon the I2 heterogeneity. Results A total of 21,297 patients from 11 publications (seven randomized controlled trials and four non-randomized controlled trials including prospective cohort studies) were retrieved. This included 6065 ( n = 28.4%) of the patients treated in the mobile stroke unit and 71.6% ( n = 15,232) of the patients managed in the conventional care. The mean age at clinical presentation (70.1 ± 14.5 vs. 71.05 ± 15.8) and National Institute Health Stroke Scale (9.8 ± 1.7 vs. 8.4 ± 1.5) was comparable ( p > 0.05) in patients treated with mobile stroke unit and conventional care, respectively. The mean time-to-treatment window was significantly shorter among the patients treated in mobile stroke unit compared to conventional care (62.0 min vs. 75.0 min; p = 0.03, respectively). The pooled analysis of clinical outcome at day 7 indicated that patients treated in mobile stroke unit had 1.46-folds higher likelihood of better clinical outcome (modified Rankin scale 0–2) than those in the hospital (odds ratio: 1.46, 95% confidence interval: 1.306–2.03, p = 0.02). However, there was no significant difference in terms of mortality (odds ratio: 0.98, 95% confidence interval: 0.81–1.18, p = 0.80), stroke-related neurological deficits (odds ratio: 1.37, 95% confidence interval: 0.81–2.32, p = 0.24), and other serious adverse events (odds ratio: 0.69, 95% confidence interval: 0.39–1.20, p = 0.19) among patients treated in mobile stroke unit versus conventional care. Conclusion Our results corroborate that patients treated in mobile stroke unit lead to short-term recovery following acute stroke without influencing the mortality rate. Further prospective studies are needed to validate our results.

A mobile stroke unit may not significantly improve the functional outcome in patients with acute stroke compared to standard medical care

2020 ◽  
Vol 15 (8) ◽  
pp. 930-931
Author(s):  
Feng Zheng ◽  
Jianfeng Zhou ◽  
Tianzao Huang ◽  
Cui′e Wang ◽  
Weipeng Hu ◽  
...  
Keyword(s):  
Medical Care ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Stroke Unit ◽  
Standard Medical Care ◽  
Mobile Stroke Unit

Application of Mobile Stroke Unit in Prehospital Thrombolysis of Acute Stroke: Experience from China

2021 ◽  
pp. 1-6
Author(s):  
Tengfei Zhou ◽  
Liangfu Zhu ◽  
Meiyun Wang ◽  
Tianxiao Li ◽  
Yucheng Li ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Acute Stroke ◽  
Sample Size ◽  
Stroke Unit ◽  
Early Stage ◽  
Intravenous Thrombolysis ◽  
Small Sample ◽  
Control Group ◽  
Prehospital Thrombolysis ◽  
Mobile Stroke Unit

<b><i>Background and Purpose:</i></b> Most patients cannot receive intravenous thrombolytic therapy in the early stage of stroke onset, and the application of mobile stroke unit (MSU) in prehospital intravenous thrombolytic therapy of acute stroke may change this situation. The first MSU in China was put into use in 2017. Herein, we aimed to explore the preliminary experience of MSU in prehospital thrombolysis of acute stroke. <b><i>Methods:</i></b> Patients who received prehospital intravenous thrombolytic therapy using MSU were classified to the MSU thrombolysis group, and the control group consisted of stroke patients admitted by regular ambulances, who were transferred to hospital for intravenous thrombolytic therapy. The feasibility, safety, and duration of procedures were compared. <b><i>Results:</i></b> There were 14 patients received prehospital intravenous thrombolysis on the MSU, and 24 patients underwent intravenous thrombolysis in the emergency center, who were transferred by the ordinary ambulance during the same period. The median call-to-needle time was 59.5 min in the MSU thrombolysis group, while it was 89 min in the control group; the difference between the 2 groups was statistically significant (<i>p</i> = 0.001). The median time from onset to thrombolysis was 70 and 102.5 min, respectively, in the 2 groups (<i>p</i> = 0.002). The percentages of good clinical outcome (modified Rankin Scale score ≤ 2) at 90-day follow-up were 79 and 67%, respectively (<i>p</i> = 0.488). The rate of symptomatic intracranial hemorrhage and mortality during the perioperative period did not differ significantly between 2 groups. <b><i>Conclusion:</i></b> Despite the small sample size, our preliminary experience of the application of MSU in the prehospital thrombosis therapy seems to indicate a significant reduction in time from call to needle, the efficacy of MSU in the treatment of acute stroke needs further experiment and larger sample size to confirm.

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