17 research outputs found
Comparison of Mobile Stroke Unit With Usual Care for Acute Ischemic Stroke Management A Systematic Review and Meta-analysis
IMPORTANCE So far, uncertainty remains as to whether there is sufficient
cumulative evidence that mobile stroke unit (MSU; specialized ambulance
equipped with computed tomography scanner, point-of-care laboratory, and
neurological expertise) use leads to better functional outcomes compared
with usual care.
OBJECTIVE To determine with a systematic review and meta-analysis of the
literature whether MSU use is associated with better functional outcomes
in patients with acute ischemic stroke (AIS).
DATA SOURCES MEDLINE, Cochrane Library, and Embase from 1960 to 2021.
STUDY SELECTION Studies comparing MSU deployment and usual care for
patients with suspected stroke were eligible for analysis, excluding
case series and case-control studies.
DATA EXTRACTION AND SYNTHESIS Independent data extraction by 2
observers, following the PRISMA and MOOSE reporting guidelines. The risk
of bias in each study was determined using the ROBINS-1 and RoB2 tools.
In the case of articles with partially overlapping study populations,
unpublished disentangled results were obtained. Data were pooled in
random-effects meta-analyses.
MAIN OUTCOMES AND MEASURES The primary outcome was excellent outcome as
measured with the modified Rankin Scale (mRS; score of 0 to 1 at 90
days).
RESULTS Compared with usual care, MSU use was associated with excellent
outcome (adjusted odds ratio [OR]. 1.64; 95% CI, 1.27-2.13; P < .001;
5 studies; n = 3228). reduced disability over the full range of the mRS
(adjusted common OR, 1.39; 95% CI, 1.14 1.70; P = .001; 3 studies; n =
1563), good outcome (mRS score of 0 to 2: crude OR, 1.25; 95% CI, 1.09
1.44; P = .001; 6 studies; n = 3266). shorter onset-to-intravenous
thrombolysis (IVT) times (median reduction, 31 minutes [95% CI, 23
39]; P < .001; 13 studies; n = 3322), delivery of IVT (crude OR, 1.83;
95% CI, 1.58 2.12; P < .001; 7 studies; n = 4790), and IVT within 60
minutes of symptom onset (crude OR, 7.71; 95% CI, 4.17 14.25; P < .001;
8 studies; n = 3351). MSU use was not associated with an increased risk
of all-cause mortality at 7 days or at 90 days or with higher
proportions of symptomatic intracranial hemorrhage after IVT.
CONCLUSIONS AND RELEVANCE Compared with usual care, MSU use was
associated with an approximately 65% increase in the odds of excellent
outcome and a 30-minute reduction in onset-to-IVT times, without safety
concerns. These results should help guideline writing committees and
policy makers