Mobile stroke unit roughly halves time to diagnosis and treatment of patients with suspected stroke
Using a specialised ambulance or mobile stroke unit (MSU) to assess and treat patients who have had a suspected stroke at the site of the emergency roughly halves the time from the initial call for help to treatment decision, and could increase the number of patients eligible for life-saving treatment, according to results of a study published Online First in The Lancet Neurology.
"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 and substantially breaks, to our knowledge, all reported times or stroke management", explains Klaus Fassbender from the University of the Saarland, Homburg, Germany, lead author of the study.
Currently, the only treatment for acute ischemic stroke (in which blood flow to an area of the brain is blocked or reduced) is thrombolysis using the clot-busting drug alteplase (recombinant tissue plasminogen activator) within 4.5 hours of symptom onset. Patients must have computed tomography (CT) scans of the brain before treatment begins to confirm that a clot is the cause of the stroke. Fewer than 15% to 40% of patients arrive at the hospital early enough for treatment, and only an estimated 2% to 5% of eligible patients actually receive thrombolysis.
In this study, 100 patients with a suspected stroke were randomly assigned to receive either treatment before they reached hospital in a MSU equipped with a CT scanner, point-of-care laboratory, and telemedicine (53 patients) or optimised standard hospital-based stroke treatment (47 patients).*
Prehospital treatment substantially reduced the median time from alarm (emergency call) to therapy decision compared with hospital care (35 min vs 76 min). The MSU also lowered the time from symptom onset to therapy decision time to less than an hour for 57% of patients compared with just 4% in the hospital-care group.
Additionally, the time from alarm to thrombolysis was also substantially shorter in the MSU group (38 min vs 73 min).
The authors say: "According to the generally accepted 'time is brain' concept, such a large reduction in delay should translate into improved outcome...although in secondary analyses no significant difference was recorded in the numbers of patients who received thrombolysis or in neurological outcome."
They conclude: "Although the effect on clinical outcome needs further study in larger (eg, multicentre) trials, the results of this first randomised trial of the MSU strategy of bringing the hospital to the patient with stroke show that guideline-adherent diagnosis and therapy can be reliably delivered within the first 35 min after alarm, thus speeding up acute stroke management."
In an accompany Comment, Peter Rothwell and Alastair Buchan from Oxford University, UK, say: "The generalisability of the trial findings to potential MSU services elsewhere will depend very much on the setting. This trial was set in an urban area with a median distance from the patient to the hospital of 7km and median alarm to arrival times of 8 minutes for the standard ambulance versus 12 minutes for the MSU. The MSU would potentially work less well in rural areas in which locally based ambulances might be able to get patients to hospital about as quickly as a hospital-situated MSU could get out to the patient. Nevertheless, this trial has shown convincingly that in at least some settings an MSU-based service is feasible and can substantially reduce delays to treatment.
More information: *The trial was stopped early after a planned interim analysis at 100 of 200 planned patients because prespecified criteria for study termination had been met.
Provided by Lancet
- New stroke research could save lives and millions of dollars Oct 23, 2008 | not rated yet | 0
- Study opens way for later treatment of acute stroke Sep 15, 2008 | not rated yet | 0
- Arrival method, slow response often delay stroke care Aug 08, 2008 | not rated yet | 0
- Women less likely to receive critical care after a stroke, researchers find Feb 19, 2009 | not rated yet | 0
- Not a moment to lose in therapy for acute stroke Sep 24, 2008 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
gravity is std. therefore can we rate a 'mass at height' by watts?
54 minutes ago For example.... wind turbines are primarily listed by their wattage (1.5MW etc.) Presumably their output is varied according to rotational speed, so...
Calculating on-axis elements of a solenoid
12 hours ago I wanted to mention that this solenoid has many winds over many layers. The thickness of the windings is 2.4 inches coming off of the engineering...
latitude & longitude & air pressure
14 hours ago Hi there, I have a peculiar question. Imagine that you are in a earth position, obtained by google, that gives you the latitude and longitude....
Differences of Classical Mechanics when learned with Calc vs algebra?
17 hours ago what are the differences? Every example I find usually has a derivative or integral or some kind of calculus defined concept that seems to make it...
what is the distance traveled
21 hours ago A rough sketch of experiment. Image: http://i43.tinypic.com/14t4sk5.png the red dots represent a side view of path traveled, F is downward force...
Image of a Convex Lens Cut in Half Horizontally
May 22, 2013 Hello everyone, A friend of mine came up with this question in class and I really do not have a good answer. Suppose you have a convex lens...
- More from Physics Forums - Classical Physics
More news stories
Costs to treat stroke are projected to more than double and the number of people having strokes may increase 20 percent by 2030, according to the American Heart Association/American Stroke Association.
Cardiology 22 hours ago | not rated yet | 0
Blood thinners are the preferred treatment option to prevent heart attacks, blood clots and stroke, but they are not without risk, and not just because of their side effects. These high-risk drugs, known as anticoagulants, ...
Cardiology May 22, 2013 | not rated yet | 0
Results from a large observational study reported at EuroPCR 2013 today question whether bivalirudin is superior to heparin in the absence of GPIIb/IIIa blockade, showing similar 30-day mortality in patients with non-ST segment ...
Cardiology May 22, 2013 | 5 / 5 (1) | 0
The DESolve bioresorbable coronary scaffold system achieves good efficacy and safety with low rates of late lumen loss and major coronary adverse events at six months, show first results from the pivotal DESolve Nx trial ...
Cardiology May 22, 2013 | not rated yet | 0
The Orsiro stent, which is a novel stent platform eluting sirolimus from a biodegradable polymer, demonstrated non-inferiority to the Xience Prime everolimus-eluting stent for the primary angiographic endpoint of in-stent ...
Cardiology May 21, 2013 | 5 / 5 (1) | 0
(Medical Xpress)—Research by U of T Mississauga psychology professor Glenn Schellenberg reveals that two key personality traits – openness-to-experience and conscientiousness—predict better than IQ ...
52 minutes ago | not rated yet | 0 |
Professor Michael Jennings, Deputy Director of the Institute for Glycomics at Griffith University, was part of an international team that discovered the previously unknown pathway of how the bacterium colonizes people.
30 minutes ago | 5 / 5 (1) | 0 |
Scientists at Newcastle University have shed new light on how the brain tunes in to relevant information.
26 minutes ago | 5 / 5 (1) | 0 |
Aggressive forms of bladder cancer involve the protein PODXL – a discovery that could hold the key to improved treatment, according to researchers at Lund University, Uppsala University and KTH in Sweden.
1 hour ago | 5 / 5 (1) | 0
New techniques in imaging of brain activity developed by Jean Gotman, from McGill University's Montreal Neurological Institute, and his colleagues lead to improved treatment of patients suffering from epilepsy. The combination ...
27 minutes ago | not rated yet | 0
Studying the networks of connections in the brains of people affected by schizophrenia, bipolar disease or depression has allowed Dr. Peter Williamson, from Western University, to gain a better understanding of the biological ...
26 minutes ago | not rated yet | 0