Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 9:13:803162.
doi: 10.3389/fneur.2022.803162. eCollection 2022.

A Systematic Review of Mobile Stroke Unit Among Acute Stroke Patients: Time Metrics, Adverse Events, Functional Result and Cost-Effectiveness

Jieyun Chen  1 , Xiaoying Lin  1 , Yali Cai  1 , Risheng Huang  1 , Songyu Yang  2 , Gaofeng Zhang  2
Affiliations

A Systematic Review of Mobile Stroke Unit Among Acute Stroke Patients: Time Metrics, Adverse Events, Functional Result and Cost-Effectiveness

Jieyun Chen et al. Front Neurol. .

Abstract

Background: Mobile stroke unit (MSU) is deployed to shorten the duration of ischemic stroke recognition to thrombolysis treatment, thus reducing disability, mortality after an acute stroke attack, and related economic burden. Therefore, we conducted a comprehensive systematic review of the clinical trial and economic literature focusing on various outcomes of MSU compared with conventional emergency medical services (EMS).

Methods: An electronic search was conducted in four databases (PubMed, OVID Medline, Embase, and the Cochrane Controlled Register of Trials) from 1990 to 2021. In these trials, patients with acute stroke were assigned to receive either MSU or EMS, with clinical and economic outcomes. First, we extracted interested data in the pooled population and conducted a subgroup analysis to examine related heterogeneity. We then implemented a descriptive analysis of economic outcomes. All analyses were performed with R 4.0.1 software.

Results: A total of 22,766 patients from 16 publications were included. In total 7,682 (n = 33.8%) were treated in the MSU and 15,084 (n = 66.2%) in the conventional EMS. Economic analysis were available in four studies, of which two were based on trial data and the others on model simulations. The pooled analysis of time metrics indicated a mean reduction of 32.64 min (95% confidence interval: 23.38-41.89, p < 0.01) and 28.26 minutes (95% CI: 16.11-40.41, p < 0.01) in the time-to-therapy and time-to-CT completion, respectively in the MSU. However, there was no significant difference on stroke-related neurological events (OR = 0.94, 95% CI: 0.70-1.27, p = 0.69) and in-hospital mortality (OR = 1.11, 95% CI: 0.83-1.50, p = 0.48) between the MSU and EMS. The proportion of patients with modified Ranking scale (mRS) of 0-2 at 90 days from onset was higher in the MSU than EMS (p < 0.05). MSU displayed favorable benefit-cost ratios (2.16-6.85) and incremental cost-effectiveness ratio ($31,911 /QALY and $38,731 per DALY) comparing to EMS in multiple economic publications. Total cost data based on 2014 USD showed that the MSU has the highest cost in Australia ($1,410,708) and the lowest cost in the USA ($783,463).

Conclusion: A comprehensive analysis of current research suggests that MUS, compared with conventional EMS, has a better performance in terms of time metrics, safety, long-term medical benefits, and cost-effectiveness.

Keywords: cost-effectiveness; emergency care; meta-analysis; mobile stroke unit; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Bias risk assessment for inclusion in the study.
Figure 3
Figure 3
Forest plot for change in the time from alarm to therapy decision (A), and the time from alarm to CT completion (B).
Figure 4
Figure 4
Forest plot for change in stroke-related or neurological events (A), and in-hospital mortality (B).
Figure 5
Figure 5
Pooled analysis of scores on mRS at 90 days.
Figure A1
Figure A1
Forest plot for change in the time from alarm to therapy decision [adding Helwig (19)] (A), and the time from alarm to CT completion (B).
See this image and copyright information in PMC

References

    1. Ahmadi M, Laumeier I, Ihl T, Steinicke M, Ferse C, Endres M, et al. . A support programme for secondary prevention in patients with transient ischaemic attack and minor stroke (INSPiRE-TMS): an open-label, randomised controlled trial. Lancet Neurol. (2020) 19:49–60. 10.1016/S1474-4422(19)30369-2 - DOI - PubMed
    1. Diener HC, Hankey GJ. Primary and secondary prevention of ischemic stroke and cerebral hemorrhage: JACC focus seminar. J Am Coll Cardiol. (2020) 75:1804–18. 10.1016/j.jacc.2019.12.072 - DOI - PubMed
    1. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. . Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. (2020) 76:2982–3021. 10.1016/j.jacc.2020.11.010 - DOI - PMC - PubMed
    1. Rutten-Jacobs LC, Arntz RM, Maaijwee NA, Schoonderwaldt HC, Dorresteijn LD, van Dijk EJ, et al. . Long-term mortality after stroke among adults aged 18 to 50 years. JAMA. (2013) 309:1136–44. 10.1001/jama.2013.842 - DOI - PubMed
    1. Wilcock AD, Zachrison KS, Schwamm LH, Uscher-Pines L, Zubizarreta JR, Mehrotra A. Trends among rural and urban medicare beneficiaries in care delivery and outcomes for acute stroke and transient ischemic attacks, 2008-2017. JAMA Neurol. (2020) 77:863–71. 10.1001/jamaneurol.2020.0770 - DOI - PMC - PubMed

Publication types

LinkOut - more resources