Background
Mobile stroke units (
MSU
s) reduce time to intravenous thrombolysis in acute ischemic stroke. Whether this advantage exists in densely populated urban areas with many proximate hospitals is unclear.
Methods and Results
We evaluated patients from the METRONOME (Metropolitan New York Mobile Stroke) registry with suspected acute ischemic stroke who were transported by a bi‐institutional
MSU
operating in Manhattan, New York, from October 2016 to September 2017. The comparison group included patients transported to our hospitals via conventional ambulance for acute ischemic stroke during the same hours of
MSU
operation (Monday to Friday, 9
am
to 5
pm)
. Our exposure was
MSU
care, and our primary outcome was dispatch‐to‐thrombolysis time. We estimated mean differences in the primary outcome between both groups, adjusting for clinical, demographic, and geographic factors, including numbers of nearby designated stroke centers and population density. We identified 66 patients treated or transported by
MSU
and 19 patients transported by conventional ambulance. Patients receiving
MSU
care had significantly shorter dispatch‐to‐thrombolysis time than patients receiving conventional care (mean: 61.2 versus 91.6 minutes;
P
=0.001). Compared with patients receiving conventional care, patients receiving
MSU
care were significantly more likely to be picked up closer to a higher mean number of designated stroke centers in a 2.0‐mile radius (4.8 versus 2.7,
P
=0.002). In multivariable analysis,
MSU
care was associated with a mean decrease in dispatch‐to‐thrombolysis time of 29.7 minutes (95%
CI
, 6.9–52.5) compared with conventional care.
Conclusions
In a densely populated urban area with a high number of intermediary stroke centers,
MSU
care was associated with substantially quicker time to thrombolysis compared with conventional ambulance care.
The main technical challenges encountered during the integration of our hospital's clinical information systems into our MSU were onboard network failures and incomplete clinical documentation. Future studies are necessary to determine whether such integrative efforts improve MSU care quality, and which enhancements to information systems will optimize clinical care and research efforts.
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