Telemedicine Can Replace the Neurologist on a Mobile Stroke Unit

Wu, Tzu Ching; Parker, Stephanie; Jagolino, Amanda; Yamal, José Miguel; Bowry, Ritvij; Thomas, Abraham; Yu, Amy; Grotta, James C.

doi:10.1161/strokeaha.116.015363

Cited by 70 publications

(50 citation statements)

References 9 publications

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“…On MSU weeks, the MSU is staffed by a paramedic, certified CT technologist, research nurse (RN), and a VN either an on-board or via telemedicine (TM). 5 After alert by EMS (Table 1), the MSU is dispatched and once on scene (e.g. the patient's home, workplace, etc.…”

Section: Study Interventionsmentioning

confidence: 99%

Benefits of stroke treatment delivered using a mobile stroke unit trial

Yamal

Rajan

Parker

et al. 2017

International Journal of Stroke

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Rationale Mobile stroke units speed treatment for acute ischemic stroke, thereby possibly improving outcomes. Aim To compare mobile stroke unit and standard management clinical outcomes, healthcare utilization, and cost-effectiveness in tissue plasminogen activator-eligible acute ischemic stroke patients calling 911. Sample size 693. Eighty percent power with 0.05 type I error rate to detect a difference of 0.09 in mean utility-weighted modified Rankin scale between groups. Design Phase III, multicenter, prospective cluster-randomized (mobile stroke unit versus standard management weeks) comparative effectiveness study in tissue plasminogen activator-eligible patients. Outcomes Primary: Ninety-day mean utility-weighted modified Rankin scale. Coprimary: cost-effectiveness based on EQ5D quality of life and one year poststroke costs. Analysis Two-sample t-test and linear regression adjusting for covariates; incremental cost-effectiveness ratio and net benefit regression. Results As of March 2017, 288 tissue plasminogen activator-eligible patients have been enrolled (173 in the mobile stroke unit arm and 115 in the standard management arm). Two new centers start in early 2017 with target end of recruitment September 2019. Conclusion This is the first randomized study to test for disability, healthcare utilization, and cost-effectiveness of a mobile stroke unit. The progress of the study suggests that it is feasible. Management of tissue plasminogen activator eligible acute ischemic stroke patients by a mobile stroke unit could potentially result in less disability and healthcare utilization, and be cost effective. Mobile stroke units are very costly. This trial may determine if the fixed cost can be justified by a reduction in disability and healthcare utilization. Clinical Trial Registration NCT02190500.

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Section: Study Interventionsmentioning

confidence: 99%

Benefits of stroke treatment delivered using a mobile stroke unit trial

Yamal

Rajan

Parker

et al. 2017

International Journal of Stroke

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“…Following the successes of establishing and operating the first MSUs in Germany, the earlier treatment of ischemic strokes became a reality in the United States with the launch of the first MSU in Houston, TX, in May 2014. 27 Following the initial "run-in" phase, 28 the reliability of a TM-based vascular neurologist (VN) to determine tPA eligibility compared with an OB neurologist was established, 29 along with demonstrable radiation safety of operating a portable CT scanner (radiation levels were also found to be within normal limits in the MSUs in Germany). 30 A prospective, multicenter, cluster-randomized comparative effectiveness trial (Benefits of Stroke Treatment Delivered Using a MSU compared with standard management by emergency medical services) is currently ongoing, which is expected to answer relevant questions regarding clinical benefit and cost effectiveness, including poststroke health care utilization and fixed costs of introducing and operating an MSU.…”

Section: The Mobile Stroke Unit Conceptmentioning

confidence: 99%

Bringing Emergency Neurology to Ambulances: Mobile Stroke Unit

Bowry

Grotta

2017

Semin Respir Crit Care Med

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Ischemic stroke results from blocked arteries in the brain, with earlier thrombolysis with intravenous tissue plasminogen activator (tPA) and/or mechanical thrombectomy resulting in improved clinical outcomes. Mobile Stroke Unit (MSU) can speed up the treatment with tPA and facilitate faster triage for patients to hospitals for mechanical thrombectomy. The first registry-based MSU study in Germany demonstrated faster treatment times with tPA using a MSU, a higher proportion of patients being treated within the first "golden hour," and a suggestion of improved 3-month clinical outcomes. The first multicenter, prospective, randomized clinical trial comparing MSU versus standard care was started in 2014 after the launch of the MSU in Houston, TX, demonstrating the feasibility and safety of MSU operation in the United States, and reliability of telemedicine to evaluate stroke patients for tPA eligibility. Although conclusive evidence from clinical trials to support MSUs as being cost effective and improving clinical outcomes is still needed, there are a myriad of other clinical and research applications of MSUs that could have profound implications for managing patients with neurological emergencies.

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“…The mobile stroke unit concept might become more accessbile in EMS systems worldwide when the neurological assessment can be done remotely by telemedicine neurologist as recently suggested. This would also dramatically decrease the unit's operational costs (Taskinen 2016, Wu et al 2017. However, the recent developments in stent-retriever techniques have promoted the use of advanced diagnostic imaging but these are currently only available at fully-equipped hospitals.…”

Section: Future Considerationsmentioning

confidence: 99%