Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond

Abstract

BACKGROUND Despite proven benefits, the use of single‐purpose mobile stroke units (MSUs) has raised concerns about their effective and cost‐efficient integration into clinical practice, especially when considered for operation in nonurban areas. The MSU concept may benefit from opening the indication spectrum to include frequent stroke mimics and additional emergencies. METHODS The current observational study evaluated benefits for the treatment and triage decision‐making of use of an MSU with extended capabilities (Hybrid‐MSU), also including radiography, ultrasonography, extended point‐of‐care laboratory, ECG, electroencephalography, and advanced medications. Apart from patients with a dispatch code for “stroke”, the ambulance was also dispatched to those with codes for “seizures”, “falls with head trauma”, “headache”, “unconsciousness”, “infection and pandemic”, “chest pain”, and “breathing problems”. RESULTS For 250 patients treated by the Hybrid‐MSU, but not for 250 conventionally treated patients, the prehospital diagnostic workup allowed, apart from treatment with stroke thrombolytics (n=15), prehospital administration of specific anticonvulsants (n=15), antibiotics (n=5), early secondary stroke prophylaxis with aspirin (n=49), and the Sepsis Six bundle (n=2). Prehospital diagnosis avoided 215 (86.0%) admissions to the emergency department, either by management at home (n=116, 46.4%) or by directly transferring patients to the required specialized wards (n=99, 39.6%). CONCLUSION The current study demonstrates the feasibility of the use of a Hybrid‐MSU and indicates its potential benefits for prehospital treatment and triage decision‐making. Opening the indication spectrum, together with an act‐alone ability, could be a key in the future integration of MSUs into routine health care.

Establishing an MSU service in a medium-sized German urban area—clinical and economic considerations

“…The estimated proportions of patients with ischemic stroke, transient ischemic attack (TIA), hemorrhagic stroke, and stroke mimics typically treated by MSU were taken from recent literature ( 9 , 10 ). MSU-specific metrics such as the number of cancelations, utilization rate, average distance and duration per dispatch, as well as the tPA administration rate were considered ( 11 , 12 ).…”

Prehospital stroke management and mobile stroke units

“…Specifically for this reason, a ‘Hybrid-MSU’, an MSU with extended capabilities (radiography, ultrasonography, refined POC laboratory, electrocardiography, electroencephalography and advanced medications and so on), has been tested. Results suggest that mainly cerebral conditions other than stroke, such as traumatic brain injury, subarachnoid haemorrhage and status epilepticus, may also profit from diagnosis, accurate triage decision-making and treatment directly at the emergency site [45].…”