Improving Stroke Treatment and Outcomes With Mobile Stroke Units

Bache, Kristi G; Grotta, James C.

doi:10.1001/jama.2020.25832

Cited by 9 publications

(6 citation statements)

References 11 publications

(16 reference statements)

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“…The potential rising implementation of CT-equipped mobile stroke ambulances can change the imaging discussion. [40][41][42][43] The mobile stroke unit essentially becomes an extension of the CSC and patients requiring EVT are brought directly to the neuro-angiosuite, obviating any repeated multimodal imaging and maximizing speed of treatment. Finally, advances in flat-panel CT allows for the potential for a direct-to-neuro-angiosuite approach which has been and could be implemented more widely, if the costs of imaging patients with stroke presentations not due to LVO can be justified.…”

Section: Future: Can We Have Our Cake and Eat It Too?mentioning

confidence: 99%

Should Primary Stroke Centers Perform Advanced Imaging?

Hill

Warach

Rostanski

2022

Stroke

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Section: Future: Can We Have Our Cake and Eat It Too?mentioning

confidence: 99%

Should Primary Stroke Centers Perform Advanced Imaging?

Hill

Warach

Rostanski

2022

Stroke

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“…We eagerly anticipate the upcoming peer-reviewed manuscript. Cost-effectiveness, implementation, and generalizability studies as well as pathways to clinical care reimbursement are key next steps that will impact the proliferation of this innovative approach [ 66 ]. Where available, the ability of MSUs to perform CTA in the prehospital setting will facilitate LVO triage without the false-positive and false-negative concerns inherent to stroke severity tools or LVO devices.…”

Section: Mobile Stroke Unitsmentioning

confidence: 99%

Large Vessel Occlusion Stroke Detection in the Prehospital Environment

Patrick

Smith

Keenan

2021

Curr Emerg Hosp Med Rep

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Purpose of Review Endovascular therapy for acute ischemic stroke secondary to large vessel occlusion (LVO) is time-dependent. Prehospital patients with suspected LVO stroke should be triaged directly to specialized stroke centers for endovascular therapy. This review describes advances in LVO detection among prehospital suspected stroke patients. Recent Findings Clinical prehospital stroke severity tools have been validated in the prehospital setting. Devices including EEG, SSEPs, TCD, cranial accelerometry, and volumetric impedance phase-shift-spectroscopy have recently published data regarding LVO detection in hospital settings. Mobile stroke units bring thrombolysis and vessel imaging to patients. Summary The use of a prehospital stroke severity tool for LVO triage is now widely supported. Ease of use should be prioritized as there are no meaningful differences in diagnostic performance amongst tools. LVO diagnostic devices are promising, but none have been validated in the prehospital setting. Mobile stroke units improve patient outcomes and cost-effectiveness analyses are underway.

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“…The role of mobile stroke units and well-trained paramedics to handle stroke cases have been emphasised in several studies. 47–54 In several studies, mobile stroke unit with trained personnel, and not regular ambulance significantly reduces the disability at 3 months for patients with acute ischaemic stroke. 48,50,51,53,54 A mobile stroke unit is always well-equipped to manage a stroke patient and reduce the extent of neurological damage delays may cause.…”

Section: Discussionmentioning

confidence: 99%

“…47–54 In several studies, mobile stroke unit with trained personnel, and not regular ambulance significantly reduces the disability at 3 months for patients with acute ischaemic stroke. 48,50,51,53,54 A mobile stroke unit is always well-equipped to manage a stroke patient and reduce the extent of neurological damage delays may cause. According to Wendt et al, 54 the triage of patients with cerebrovascular events to specialized hospitals can be improved by Stroke Emergency Mobile (STEMO) ambulances.…”

Section: Discussionmentioning

confidence: 99%

Exploring the Essential Stroke Care Structures in Tertiary Healthcare Facilities in Rivers State, Nigeria

Osuegbu

Adeniji

Owhonda

et al. 2022

INQUIRY

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This study evaluated the essential stroke care structure available in the two Tertiary Health Facilities in Rives State, Nigeria. This was a descriptive survey involving the Stroke Care Survey and Assessment Tool (checklist/questionnaire) developed by the World Stroke Organisation to obtain information about the available essential stroke care structure (facilities, equipment, personnel and management protocol) at the two tertiary health facilities (RSUTH & UPTH). The study gathered relevant information, which was summarised into tables and graphs using Microsoft Excel 2016. From the results, although facilities had A and E departments, dedicated stroke units (fixed or mobile) were unavailable, and there was no locally developed protocol to support rapid triage of stroke patients. The facilities and equipment were either unavailable or insufficient. Only one health facility (RSUTH) provided 24 hrs/7 days laboratory services. The workforces were a mix between regular clinical staff and some specialists. Tissue plasminogen activator (tPA) use was non-existent, though specialists were trained on its administration. There was no locally developed or adopted stroke-specific clinical guidelines. In conclusion, the structural services available for stroke care within the studied tertiary health facilities were poor, unavailable or grossly insufficient. The state facility (RSUTH) suffered the most in terms of unavailable national support and staff development.

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Improving Stroke Treatment and Outcomes With Mobile Stroke Units

Cited by 9 publications

References 11 publications

Should Primary Stroke Centers Perform Advanced Imaging?

Should Primary Stroke Centers Perform Advanced Imaging?

Large Vessel Occlusion Stroke Detection in the Prehospital Environment

Exploring the Essential Stroke Care Structures in Tertiary Healthcare Facilities in Rivers State, Nigeria

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