John C. Probasco, MD reviewing Taqui A et al. Neurology 2017 Mar 8. Southerland AM and Brandler ES. Neurology 2017 Mar 8.

A dedicated telemedicine-enabled stroke ambulance equipped with a CT scanner allowed delivery of IV thrombolysis 38.5 minutes faster than conventional ischemic stroke care delivery in an urban setting.

A telemedicine-enabled ambulance-based mobile stroke treatment unit (MSTU) was developed by an academic medical center and emergency medical services (EMS) in Cleveland to improve alarm-to-treatment time for patients experiencing acute ischemic stroke. The MSTU was outfitted with a mobile computed tomography (CT) scanner and point-of-care laboratory equipment and was staffed by a registered nurse, a paramedic, an emergency medicine technician, a CT technologist, and a vascular neurologist via telemedicine.

Researchers compared data for the first 100 patients evaluated in the MSTU and a control cohort of 53 patients brought directly by EMS to the tertiary facility or affiliated hospitals for evaluation and treatment of stroke over a 1-year period. The MSTU and control cohorts were well matched, including by stroke severity (median NIH stroke scale scores, 6 and 7).

Thirty-three MSTU patients were diagnosed with probable acute ischemic stroke, of whom16 (48%) received IV thrombolysis. Twelve controls received thrombolysis. Median symptom onset-to-thrombolysis time was 25.5 minutes shorter in the MSTU group than for controls (97.0 vs. 122.5 minutes); median alarm-to-thrombolysis time was 38.5 minutes shorter (55.5 vs. 94.0 minutes). Four of 16 MSTU patients, compared with no controls, received IV thrombolysis within 60 minutes of symptom onset.

CITATION(S):

Taqui A et al. Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis. Neurology 2017 Mar 8; [e-pub].

Southerland AM and Brandler ES.The cost-efficiency of mobile stroke units: Where the rubber meets the road. Neurology 2017 Mar 8; [e-pub].

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