Investigating the Impact of Mobile Stroke Units

The World Health Organization reports that globally, 15 million people suffer a stroke each year. An estimated 33 percent are fatal while the remainder of patients experience ongoing physical and mental complications. The estimated cost is nearly $70 billion in the US alone.

Traditionally, patients who present with signs and symptoms of a stroke are often brought in by EMS, costing delays in diagnosis and lifesaving treatment. But could mobile stroke units (MSUs) be the secret to success?

What’s the Impact?

MSUs are ambulances outfitted with additional equipment (e.g., point-of-care lab and CT scanner) and personnel (e.g., vascular neurologist, registered nurse with acute stroke and research experience, CT technician, and a registered EMT-P).

To find out if MSUs could be the key to enhancing immediate stroke care, the first-ever, observational, prospective, multisite, alternating-week, culture-controlled clinical trial was conducted. Dr. James Grotta compared traditional pre-hospital triage (EMS) and transport to care provided by MSUs in 911 calls for suspected acute neurological deficits.

Data showcasing the success of the BEST-MSU (BEnefits of Stroke Treatment Delivered Using a Mobile Stroke Unit) group was presented at the International Stroke Conference in February 2022. Major outcomes from this study included:

• Increase in the number of patients who were eligible and received treatment

• Better/improved quality and quantity of life for patients

• Cost-effectiveness of MSUs

Here’s how Dr. Grotta and his research team reached those major outcomes.

Between August 2014 and August 2020, BEST-MSU enrolled 1,515 patients eligible for tissue plasminogen activator (t-PA), which is the firstline treatment against strokes. Of the 1,515 patients, 617 patients in the MSU group (32.9 percent) and 430 in the EMS group (2.6 percent) were eligible to receive t-PA. Ultimately, the researchers concluded that the timely information that was provided to MSUs enabled the patient care team to make more effective triage, transport, and care decisions.

To assess the effectiveness of MSUs, a utility-weighted modified Rankin Scale was used. Specifically, utility weight was determined using the Euro-QoL EQ-5D-5L instrument and the modified Rankin Scale to evaluate the extent of disability/dependence of patients who experienced a stroke on daily functions.

After a 90-day follow-up, t-PA eligible MSU patients achieved better outcomes (no or minimal disability).

Lastly, the cost-effectiveness of MSUs was determined by the amount of healthcare payer reimbursement compared to controls after adjustment for Medicare and Medicaid geographic area and practice costs. And once again, it was found that MSUs outperformed the EMS group in terms of cost-effectiveness as well.

What’s Next?

After laying a successful foundation through the BEST-MSU study, additional research related to the COVID-19 pandemic is being further investigated. With the prevalence and complications of cardiovascular disease increasing, a call for more MSU teams is imperative, and this study further lays a strong foundation for the speed necessary in other clinical applications. Ready to assemble your BEST- MSU team?  

References

Dugas, Emma. 2021. “New Research Shows the ‘Drive’ Behind Better Stroke Care.” Vitals by Sutter Health. September 8, 2021. https://vitals.sutterhealth.org/clinical-outcomes-with-mobile-stroke-unit/.

2022. “Mobile Stroke Units Prove Their Worth.” Vitals by Sutter Health. March 1, 2022. https://vitals.sutterhealth.org/mobile-stroke-units-prove-their-worth/?sf161472969=1.

Grotta, James. 2016a. “Comparing Mobile Stroke Treatment with Emergency Room Care -- the BEST-MSU Study.” Patient-Centered Outcomes Research Institute. 2016. https://www.pcori.org/research-results/2016/comparing-mobile-stroke-treatment-emergency-room-care-best-msu-study.

2016b. “Comparing Mobile Stroke Treatment with Emergency Room Care -- the BEST-MSU Study.” Patient-Centered Outcomes Research Institute. July 2016. https://www.pcori.org/research-results/2016/comparing-mobile-stroke-treatment-emergency-room-care-best-msu-study.

2019. “BEnefits of Stroke Treatment Delivered Using a Mobile Stroke Unit Compared to Standard Management by Emergency Medical Services: The BEST-MSU Study.” U.S. National Library of Medicine. Houston: U.S. National library of Medicine. https://clinicaltrials.gov/ProvidedDocs/00/NCT02190500/Prot_000.pdf.

Grotta, James C., Jose-Miguel Yamal, Stephanie A. Parker, Suja S. Rajan, Nicole R. Gonzales, William J. Jones, Anne W. Alexandrov, et al. 2021. “Prospective, Multicenter, Controlled Trial of Mobile Stroke Units.” The New England Journal of Medicine 385 (11): 971–81. https://doi.org/10.1056/NEJMOA2103879.

“Stroke, Cerebrovascular Accident.” n.d. World Health Organization. Accessed March 23, 2022. http://www.emro.who.int/health-topics/stroke-cerebrovascular-accident/index.html.