Prehospital stroke management and mobile stroke units

Faßbender, Klaus; Lesmeister, Martin; Merzou, Fatma

doi:10.1097/wco.0000000000001150

Cited by 5 publications

(1 citation statement)

References 47 publications

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“…In our analyses, we assumed that time to thrombolysis fully mediates the effect of MSU care. Even though there is little doubt that this is the main mechanism by which MSU care exerts its effect on functional outcomes, we cannot absolutely rule out other minor mechanisms as possible pathways (e.g., improved diagnostic capabilities because of MSU staff or better triage 17 ). We estimated a cOR of 0.88 (0.97 in the sensitivity analysis considering more confounding variables), which was weaker than expected considering prior B_PROUD analyses.…”

Section: Discussionmentioning

confidence: 98%

The Effect of Mobile Stroke Unit Care on Functional Outcomes: An Application of the Front-door Formula

et al. 2023

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Background: The Berlin-based B_PROUD study was designed to assess the effect of Mobile Stroke Unit (MSU) dispatch among ischemic stroke and transient ischemic attack (TIA) patients without contraindications to reperfusion treatments. However, a large proportion of patients for whom the MSU was dispatched did not ultimately receive MSU care. We estimated the causal effect of additional MSU care on 3-month functional outcomes among B_PROUD patients for whom an MSU was dispatched. Methods: We used data from the B_PROUD study (1 February 2017-8 May 2019). Given the presence of exposure–outcome unmeasured confounding, we used the front-door formula to identify the distribution of modified Rankin scale (mRS) outcomes under two hypothetical interventions: (1) receiving additional MSU care and (2) only receiving conventional care. We considered time from dispatch to thrombolysis as the full mediator, and adjusted for exposure–mediator and mediator–outcome confounding. We used a parametric estimator to estimate common odds ratio (cOR) and 95% bootstrapped confidence intervals (CI). Results: We included in total 768 ischemic stroke/TIA patients with MSU dispatch. The MSU was cancelled for 180 (23%) patients, while 588 (77%) received MSU care. The unadjusted association between care group and mRS favored conventional care (cOR=1.7, 95% CI=1.2-2.3); however, after applying the front-door formula, the mRS distribution favored MSU care (cOR=0.88, 95% CI=0.81-0.96). Conclusions: Receiving MSU care was associated with better functional outcomes than conventional care only, compatible with the hypothesized beneficial effect of MSU care on post-stroke outcomes, among stroke and TIA patients without contraindications to reperfusion treatments.

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Section: Discussionmentioning

confidence: 98%