Comparing performance measures and clinical outcomes between mobile stroke units and usual care in underserved areas
Issued Date
2023-04-01
Resource Type
ISSN
15901874
eISSN
15903478
Scopus ID
2-s2.0-85143779943
Pubmed ID
36515765
Journal Title
Neurological Sciences
Volume
44
Issue
4
Start Page
1261
End Page
1271
Rights Holder(s)
SCOPUS
Bibliographic Citation
Neurological Sciences Vol.44 No.4 (2023) , 1261-1271
Suggested Citation
Nilanont Y., Chanyagorn P., Shukij K., Pengtong W., Kongmuangpuk M., Wongmayurachat K., Nittayaboon K., Wongsawat Y., Sirovetnukul R., Chakorn T., Riyapan S., Kaveeta C., Chotik-anuchit S., Tongdee T., Thabmontian P., Saeheng P., Nopmaneejumruslers C., Vamvanij V. Comparing performance measures and clinical outcomes between mobile stroke units and usual care in underserved areas. Neurological Sciences Vol.44 No.4 (2023) , 1261-1271. 1271. doi:10.1007/s10072-022-06550-6 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/82350
Title
Comparing performance measures and clinical outcomes between mobile stroke units and usual care in underserved areas
Author's Affiliation
Other Contributor(s)
Abstract
Background: The efficacy of mobile stroke units (MSUs) in improving acute ischemic stroke (AIS) care in developing countries is unknown. We compared performance measures and stroke outcomes in AIS patients between MSU and usual care: emergency medical services (EMS) and walk-in. Methods: We enrolled patients > 18 years of age with an AIS within 4.5 h after onset. Demographic data, types, and time of reperfusion therapies and clinical outcomes were recorded. A favorable outcome was defined as a modified Rankin Scale (mRS) 0–2 at 3 months. Results: A total of 978 AIS patients (MSU = 243, EMS = 214, walk-in = 521) were enrolled between June 1, 2018, and April 30, 2021. The mean age (± SD) was 66 (± 14) years, and 510 (52.1%) were male. AIS time metrics were the shortest in the MSU with a mean (± SD) door to needle (DN) time of 20 (± 7), 29 (± 13), and 35 (± 16) min (p < 0.001) and door to puncture (DP) time of 73 ± 19, 86 ± 33, and 101 ± 42 min (p < 0.001) in MSU, EMS, and walk-in, respectively. Participants in the MSU (56.8%) received higher rate of reperfusion therapie(s) when compared to the EMS (51.4%) and walk-in (31.5%) (p < 0.001). After adjustment for any potential confounders and using the EMS as a reference, the MSU has the highest likelihood of achieving a favorable outcome (adjusted OR 2.15; 95% CI 1.39–3.32). Conclusions: In underserved populations, MSUs significantly reduced DN time, increased the likelihood of receiving reperfusion treatment, and achieved independency at 3 months when compared to usual care.