Mobile Stroke Unit Treatment Times and Transport Frequency in a Suburban Setting

BackgroundThe majority of Mobile Stoke Units (MSUs) operate in European and United States urban cities. Questions remain on the cost-effectiveness, setting (urban, suburban, or rural), infrastructure and support, and reimbursement of these units. We present our experiences of a single-center MSU in a suburban setting, with treatment times, challenges, and possible future directions of alternative methods of care. MethodsRetrospective analysis of prospectively collected data from Mobile Stroke Unit calls for service and Get With The Guidelines-Stroke data from two primary stroke centers from December 2017 through February 2020 comparing patients receiving intravenous thrombolysis and treatment times. ResultsThere were no differences in age, sex, medical history, or stroke severity between MSU transport when compared to standard transport. There were differences in patient racial and ethnic demographics between groups, with higher white race and Hispanic ethnicity. Door-to-needle time was 48.9 minutes for patients seen on the Rush MSU versus 67.2 minutes for patients seen via traditional EMS transport (p=0.04). ConclusionsThe Rush MSU demonstrated significant reduction of acute ischemic stroke treatment time with intravenous thrombolysis, but did not demonstrate the patient volume necessary to justify continued operation. Suburban and rural regions do benefit from pre-hospital stroke evaluation, however the ideal method for a cost-effective strategy is still unknown.