Mobile Stroke Units in Acute Ischemic Stroke: A Comprehensive Systematic Review and Meta-Analysis of 5 “T Letter” Domains

Abstract

Intravenous thrombolysis (IVT) may be administered to stroke patients requiring immediate treatment more quickly than emergency medical services if certain conditions are met. These conditions include the presence of mobile stroke units (MSUs) with on-site treatment teams and a computed tomography scanner. We compared clinical outcomes of MSU conventional therapy by emergency medical services through a systematic review and meta-analysis. We searched key electronic databases from inception till September 2021. The primary outcomes were mortality at 7 and 90 days. The secondary outcomes included the modified Rankin Scale score at 90 days, alarm to IVT or intra-arterial recanalization, and time from symptom onset or last known well to thrombolysis. We included 19 controlled trials and cohort studies to conduct our final analysis. Our comparison revealed that 90-day mortality significantly decreased in the MSU group compared with the conventional care group [risk ratio = 0.82; 95% confidence interval (CI), 0.71–0.95], while there was no significant difference at 7 days (risk ratio = 0.89; 95% CI, 0.69–1.15). MSU achieved greater functional independence (modified Rankin Scale = 0–2) at 90 days (risk ratio = 1.08; 95% CI, 1.01–1.16). MSU was associated with shorter alarm to IVT or intra-arterial recanalization time (mean difference = −29.69; 95% CI, −34.46 to −24.92), treating patients in an earlier time window, as shown through symptom onset or last known well to thrombolysis (mean difference = −36.79; 95% CI, −47.48 to −26.10). MSU-treated patients had a lower rate of 90-day mortality and better 90-day functional outcomes by earlier initiation of IVT compared with conventional care.