Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial
The Lancet Neurology,  Clinical Article

Walter S et al. – For patients with suspected stroke, treatment by the mobile stroke unit (MSU) substantially reduced median time from alarm to therapy decision. The MSU strategy offers a potential solution to the medical problem of the arrival of most stroke patients at the hospital too late for treatment.

Methods
  • The authors did a randomised single-centre controlled trial to compare the time from alarm (emergency call) to therapy decision between mobile stroke unit (MSU) and hospital intervention.
  • For inclusion in the study patients needed to be aged 18-80 years and have one or more stroke symptoms that started within the previous 2.5 h.
  • In accordance with the week-wise randomisation plan, patients received either prehospital stroke treatment in a specialised ambulance (equipped with a CT scanner, point-of-care laboratory, and telemedicine connection) or optimised conventional hospital-based stroke treatment (control group) with a 7 day follow-up.
  • Allocation was not masked from patients and investigators.
  • The primary endpoint was time from alarm to therapy decision, which was analysed with the Mann-Whitney U test.
  • The secondary endpoints included times from alarm to end of CT and to end of laboratory analysis, number of patients receiving intravenous thrombolysis, time from alarm to intravenous thrombolysis, and neurological outcome.
  • They also assessed safety endpoints.

Results
  • They stopped the trial after the planned interim analysis at 100 of 200 planned patients (53 in the prehospital stroke treatment group, 47 in the control group), because they had met the prespecified criteria for study termination.
  • Prehospital stroke treatment reduced the median time from alarm to therapy decision substantially: 35 min (IQR 31-39) versus 76 min (63-94), p<0.•0001; median difference 41 min (95% CI 36-48 min).
  • They also detected similar gains regarding times from alarm to end of CT, and alarm to end of laboratory analysis, and to intravenous thrombolysis for eligible ischaemic stroke patients, although there was no substantial difference in number of patients who received intravenous thrombolysis or in neurological outcome.
  • Safety endpoints seemed similar across the groups.

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Neurology

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Neurology Articles

1 Zolpidem and the risk of Parkinson's disease: A nationwide population-based study Journal of Psychiatric Research, August 1, 2014    Clinical Article

2 Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial The Lancet, October 17, 2014    Evidence Based Medicine    Clinical Article
Exclusive Author Commentary

3 Safety and efficacy of ceftriaxone for amyotrophic lateral sclerosis: A multi-stage, randomised, double-blind, placebo-controlled trial The Lancet Neurology, October 9, 2014    Clinical Article

4 Recurrent stroke in the warfarin versus aspirin in reduced cardiac ejection fraction (WARCEF) trial Cerebrovascular Diseases, October 16, 2014    Clinical Article

5 Dairy products and the risk of stroke and coronary heart disease: the Rotterdam Study European Journal of Nutrition, October 14, 2014    Clinical Article

6 Hyperhomocysteinemia and risk of cognitive decline: a meta-analysis of prospective cohort studies European Neurology, October 17, 2014    Review Article

7 Intracranial hemorrhage risk with the new oral anticoagulants: A systematic review and meta-analysis Journal of Neurology, September 2, 2014    Evidence Based Medicine    Review Article

8 Patent foramen ovale closure versus medical therapy for stroke prevention: meta analysis of randomized trials and review of heterogeneity in meta analyses Canadian Journal of Cardiology, August 7, 2014    Evidence Based Medicine    Review Article    Clinical Article

9 Consumption of nuts and legumes and risk of stroke: a meta-analysis of prospective cohort studies Nutrition, Metabolism & Cardiovascular Diseases, July 28, 2014    Evidence Based Medicine    Clinical Article

10 Effects of long-term blood pressure lowering and dual antiplatelet treatment on cognitive function in patients with recent lacunar stroke: a secondary analysis from the SPS3 randomised trial The Lancet Neurology, October 27, 2014    Evidence Based Medicine    Clinical Article

11 Antiepileptics in migraine prophylaxis: An updated Cochrane review Cephalalgia, August 14, 2014    Clinical Article

12 The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT) The Lancet, October 30, 2014    Evidence Based Medicine    Clinical Article

13 Circulating biomarkers of dairy fat and risk of incident stroke in US men and women in 2 large prospective cohorts American Journal of Clinical Nutrition, October 1, 2014    Clinical Article

14 Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: A nationwide cohort study American Journal of Medicine, September 29, 2014    Clinical Article

15 Antiplatelet strategies for secondary prevention of stroke and TIA Current Atherosclerosis Reports, September 11, 2014    Review Article

16 Management of high-grade gliomas in the elderly Seminars in Radiation Oncology, October 6, 2014    Clinical Article

17 Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial European Heart Journal, September 17, 2014    Clinical Article

18 Long-term outcomes after combined revascularization surgery in adult moyamoya disease Stroke, October 8, 2014    Evidence Based Medicine    Clinical Article

19 Oral anticoagulants for stroke prevention in atrial fibrillation Current Problems in Cardiology, September 23, 2014    Review Article

20 Potassium intake and risk of stroke in women with hypertension and nonhypertension in the women’s health initiative Stroke, September 24, 2014    Clinical Article

Indexed Journals in Neurology: Current Opinion in Neurology, Stroke, Seizure, Cephalgia, Brain Injurymore