ImportanceClinical trials have suggested that prehospital management in a mobile stroke unit (MSU) improves functional outcomes in patients with acute ischemic stroke who are potentially eligible for intravenous thrombolysis, but there is a paucity of real-world evidence from routine clinical practice on this topic.ObjectiveTo determine the association between prehospital management in an MSU vs standard emergency medical services (EMS) management and the level of global disability at hospital discharge.Design, Setting, and ParticipantsThis was a retrospective, observational, cohort study that included consecutive patients with a final diagnosis of ischemic stroke who received either prehospital management in an MSU or standard EMS management between August 1, 2018, and January 31, 2023. Follow-up ended at hospital discharge. The primary analytic cohort included those who were potentially eligible for IV thrombolysis. A separate, overlapping cohort including all patients regardless of diagnosis was also analyzed. Patient data were obtained from the American Heart Association’s Get With The Guidelines–Stroke (GWTG-Stroke) Program, a nationwide, multicenter quality assurance registry. This analysis was completed in May 2024.ExposurePrehospital management in an MSU (vs standard EMS management).Main Outcomes and MeasuresThe primary efficacy end point was the utility-weighted modified Rankin Scale (UW-mRS) score. The secondary efficacy end point was independent ambulation status. The coprimary safety end points were symptomatic intracranial hemorrhage (sICH) and in-hospital mortality.ResultsOf 19 433 patients (median [IQR] age, 73 [62-83] years; 9867 female [50.8%]) treated at 106 hospitals, 1237 (6.4%) received prehospital management in an MSU. Prehospital management in an MSU was associated with a better score on the UW-mRS at discharge (adjusted mean difference, 0.03; 95% CI, 0.01-0.05) and a higher likelihood of independent ambulation at discharge (53.3% [468 of 878 patients] vs 48.3% [5868 of 12 148 patients]; adjusted risk ratio [aRR], 1.08; 95% CI, 1.03-1.13). There was no statistically significant difference in sICH (5.2% [57 of 1094] vs 4.2% [545 of 13 014]; aRR, 1.30; 95% CI, 0.94-1.75]) or in-hospital mortality (5.7% [70 of 1237] vs 6.2% [1121 of 18 196]; aRR, 1.03; 95% CI, 0.78-1.27) between the 2 groups.Conclusions and RelevanceAmong patients with acute ischemic stroke potentially eligible for intravenous thrombolysis, prehospital management in an MSU compared with standard EMS management was associated with a significantly lower level of global disability at hospital discharge. These findings support policy efforts to expand access to prehospital MSU management.

中文翻译：

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符合静脉溶栓条件的急性缺血性卒中患者的移动卒中单元管理


重要性临床试验表明，移动卒中单元 （MSU） 的院前管理可改善可能符合静脉溶栓条件的急性缺血性卒中患者的功能结局，但缺乏来自常规临床实践的关于该主题的真实世界证据。目的确定 MSU 与标准紧急医疗服务 （EMS） 管理的院前管理与出院时整体残疾水平之间的关联。设计、设置和参与者这是一项回顾性、观察性、队列研究，包括 2018 年 8 月 1 日至 2023 年 1 月 31 日期间在 MSU 接受院前管理或标准 EMS 管理的连续缺血性卒中患者。随访在出院时结束。主要分析队列包括那些可能符合静脉溶栓条件的人。还分析了一个单独的、重叠的队列，包括所有患者，无论诊断如何。患者数据来自美国心脏协会的 Get With The Guidelines–中风 （GWTG-Stroke） 计划，这是一个全国性的多中心质量保证登记处。该分析于 2024 年 5 月完成。主要结局和测量主要疗效终点是效用加权改良 Rankin 量表 （UW-mRS） 评分。次要疗效终点是独立行走状态。共同主要安全性终点是症状性颅内出血 （sICH） 和院内死亡率。结果在 106 家医院治疗的 19 433 例患者 （中位 [IQR] 年龄，73 [62-83] 岁;9867 例女性 [50.8%]）中，1237 例 （6.4%） 在 MSU 接受了院前管理。 MSU 的院前管理与出院时 UW-mRS 评分较高相关（校正均数差，0.03;95% CI，0.01-0.05）和出院时独立行走的可能性更高（53.3% [878 例患者中的 468 例] vs 48.3% [12 148 例患者中的 5868 例];调整后风险比 [aRR]，1.08;95% CI，1.03-1.13）。两组之间的 sICH （5.2% [1094 中的 57] vs 4.2% [13 014 中的 545];aRR，1.30;95% CI，0.94-1.75]）或院内死亡率（5.7% [1237 中的 70] vs 6.2% [18 196 中的 1121];aRR，1.03;95% CI，0.78-1.27）无统计学意义差异。结论和相关性在可能符合静脉溶栓条件的急性缺血性卒中患者中，与标准 EMS 管理相比，MSU 的院前管理与出院时整体残疾水平显著降低相关。这些发现支持扩大院前 MSU 管理可及性的政策努力。