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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.

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Previous studies from this laboratory have shown that pretreatment with phenytoin or phenobarbitone shortens the halflife of MISO in mice and dogs through induction of hepatic drug-metabolizing enzymes, which increase the rate of oxidative demethylation of MISO to desmethylmisonidazole (1-(2-nitroimidazol-1 -yl)-2,3-propandiol; Ro 05-9963, Roche Laboratories; NSC 261036; DEMIS) (Workman, 1979; White & Workman, 1979). In addition, pretreatment with these agents significantly reduces the acute lethal effects of MISO in mice (Workman, 1980 Blood samples were taken by venipuncture immediately before MISO administration and at various times after, usually 2, 1, 2, 4, 8, 12, 24 and 30 h. Plasma concentrations of MISO and DEMIS were determined by reverse-phase high-performance liquid chromatography (HPLC) (Workman et al., 1978a). Pharmacokinetic parameters were calculated as described previously (Workman et al., 1978b;Workman, 1979). Statistical analysis was by Student's t test.The pertinent pharmacokinetic data are summarized in Table I. Comparison of the data obtained on the first MISO dose revealed no significant differences between the control and phenytoin groups for any of the kinetic parameters (P> 0 1). This indicated that the pharmacokinetics of MISO were initially very similar for the two groups.For the control group, comparison of the data for the first and second doses of MISO showed that the percentage change for