Table 2.
Published MSU clinical outcomes and data
| Reference | Walter et al., 2012 [21] | Weber et al., 2013 [34] | Ebinger et al., 2014 [24] | Wendt et al., 2015 [35] | Ebinger et al., 2015 [32] | Wu et al., 2014 [36] | Bowry et al., 2015 [33] | Cerejo et al., 2015 [25] | Rasmussen, 2015 [37] | Itrat et al., 2016 [38] | Taqui et al., 2017 [39] | Mercy Health, 2017a | Data range | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Site | Homburg, Saarland, Germany | Berlin, Germany | Berlin, Germany | Berlin, Germany | Berlin, Germany | Houston, TX, USA | Houston, TX, USA | Cleveland, OH, USA | Cleveland, OH, USA | Cleveland, OH, USA | Cleveland, OH, USA | Toledo, OH, USA | ||
| Study design | RCT | pilot | RCT | RCT | post hoc analyses | pilot feasibility | RCT | retrospective analysis | report | prospective observational study | prospective analysis | prospective analysis | ||
| Year(s) | 2008–2011 | 2011 | 2011–2013 | 2011–2013 | 2011–2013 | UNK | May 2014 to August 2014 | 2014 | 2014–2015 | 2014–2015 | July 2014 to November 2014 | January 2016 to July 2016 | ||
| Number of stroke patients with vs. without intervention | 53 vs. 47 | 23 vs. 22 | (1,804) 3,213 vs. 2,969 | (1,804) 3,213 vs. 2,969 | (1,804) 3,213 vs. 2,969 | 40 | 24 vs. 2 | 5 | 100 vs. 56 | 100 vs. 56 | 100 vs. 53 | 105 vs. 143 | ||
| Intervention | MSU | MSU-administered tPA | STEMO deployment | STEMO deployment | STEMO deployment | in-ambulance telemedicine rapid stroke evaluation | MSU-administered treatment | MSU deployment to intra-arterial therapy | MSU-administered tPA | MSU-administered treatment | MSU-administered treatment | MSU-administered treatment | ||
| Age: mean ± SD/median (IQR) | UNK/72 (59–76) | 74 ± 12/77 (66–82) | 73.9 ± 15.0/UNK | 73.9 ± 15.0/UNK | 73.9 ± 15.0/UNK | UNK | UNK/64 | UNK/75 (51.5–81) | UNK/62 (53–76) | UNK/62 (53–76) | UNK/62 (53–78) | 70.8±15.2/73 (63–82) | 51.5–82 years old | |
| Male sex, n (%) | 31 (58.0) | 795 (44.1) | 646 (44.1) | 795 (44.1) | UNK | 13 (50.0) | 3 (60) | 46 (46) | 46 (46) | 46 (46) | 49 (46.7) | 44.1–58.0% | ||
| Hx of hypertension, n (%) | 41 (77.0) | UNK | UNK | UNK | UNK | 16 (61.5) | UNK | UNK | UNK | UNK | 63 (60.0) | 60.0–77.0% | ||
| Hx of DM, n (%) | 14 (26.0) | 451 (25.0) | 451 (25.0) | 451 (25.0) | UNK | 4 (15.4) | UNK | UNK | UNK | UNK | 27 (25.7) | 15.4–26.0% | ||
| Hx of atrial flutter or fibrillation, n (%) | 12 (23.0) | 440 (24.4) | 440 (24.4) | 440 (24.4) | UNK | 5 (19.2) | UNK | UNK | UNK | UNK | 19 (18.1) | 18.1–24.4% | ||
| Hx of stroke, n (%) | 16 (30.0) | UNK | UNK | UNK | UNK | UNK | UNK | UNK | UNK | UNK | 34 (32.4) | 30.0–32.4% | ||
| NIHSS score, median (IQR) | 5 (3–11) | 7 (4–12) | 10 (3–19) | UNK | 10 (3–19) | 8.5 | 11 (3–25) | 19 (18.5–21.5) | 6 (2–12) | 6 (2–12) | 6 (2–12) | UNK | 2–19 | |
| mRS, median (IQR) | 4 (2–5) | 1 (0–3) | UNK | UNK | UNK | UNK | UNK | UNK | UNK | UNK | UNK | UNK | 0–5 | |
| Dx of ischemic stroke | 29 (55.0) | 614 (70.9) | 610 (33.8) | 614 (70.9) | 32 | 11 (42.3) | 5 (100) | 33 (33.0) | 33 (33.0) | UNK | 43 (41.0) | 33.8–100% | ||
| Dx of TIA | 8 (15.0) | 182 (21.0) | 185 (10.3) | 182 (21.0) | 8 | 1 (3.85) | UNK | 4 (4.0) | 4 (4.0) | UNK | 13 (12.4) | 4.0–15.0% | ||
| Dx of intracranial hemorrhage | 4 (6.0) | 45 (5.2) | 45 (2.5) | 45 (5.2) | UNK | 4 (15.4) | UNK | 5 (5) | 5 (5) | UNK | 5 (4.8) | 2.5–15.4% | ||
| Thrombectomy | UNK | UNK | UNK | UNK | UNK | UNK | UNK | UNK | UNK | UNK | 8 (7.6) | 7.6% | ||
| Dx of seizure | 7 (13.0) | UNK | 129 (7.2) | UNK | UNK | 4 (15.4) | UNK | UNK | UNK | UNK | 13 (12.4) | 7.2–13.0% | ||
| Dx of brain tumor | UNK | UNK | UNK | UNK | UNK | UNK | UNK | UNK | UNK | UNK | 1 (0.95) | 0.95% | ||
| Dx of head trauma | UNK | UNK | 9 (0.5) | UNK | UNK | UNK | UNK | UNK | UNK | UNK | 1 (0.95) | 0.5–0.95% | ||
| Treated with IV tPA, n (%) | 12 (23) | 192 (10.6) | UNK | 200 (11.1) | UNK | 12 (46.2) | 5 (100) | 16 (16.0) | 16 (16.0) | 16 (16.0) | 10 (9.5) | 9.5–100% | ||
| Alarm to therapy decision, min | 35 (31–39) | UNK | UNK | UNK | 9.77 | UNK | UNK | UNK | UNK | UNK | UNK | 9.77–39 | ||
| Alarm to treatment, mean (95% CI)/median (IQR), min | UNK/38 (34–42) | 62 (21)b/58 (50–65) | 51.8 (49.0–54.6)/48 (39–56)c | UNK | 51.8 (49.0–54.6)/48 (39–56)c | 9.27 | UNK | 93 (75–116.5) | 51.8 | UNK | UNK | 50.6 (44.4–56.8)/53.0 | (42–59) | 34–116.5 |
| LKW to treatment, mean (range)/median (IQR), min | UNK/72 (53–108) | UNK | UNK | UNK | UNK | 98 (47–265)/UNK | UNK | UNK | UNK | UNK | 95.4 (40–153)/105 (52.0–128.8) | 40–265 | ||
| MSU on-scene to tPA time, mean (range), min | UNK | 48 (22)/42 (37–52)d | UNK | UNK | UNK | UNK | 25 (18–42) | UNK | UNK | UNK | UNK | 34.7 (25–49) | 18–52 | |
| Alarm to imaging, mean (95% CI)/median (IQR), min | UNK/alarm to end of imaging 34 (30–38) | 37.7 (35.6–39.7)/35 (30–42) | UNK | 37.7 (35.6–39.7)/35 (30–42) | UNK | UNK | UNK | 37.7 | UNK/alarm to end of imaging 33 (22–46) | 36 (34–38)/33 (29–41) | 29.5 (28.0–31.0)/30.0 (24.3–33.3) | 22–42 | ||
| Alarm to INR, mean (95% CI)/median (IQR), min | UNK | 30.8 (28.4–33.2)/26 (20–37) | UNK | 30.8 (28.4–33.2)/26 (20–37) | UNK | UNK | UNK | UNK | UNK | 34 (32–36)/34 (25–40) | 28.5 (21.6–35.4)/28.5 (26.8–32.0) | 20–40 | ||
| LKW to tPA <60 min, n (%) | UNK | UNK | UNK | 62 | UNK | 12 (33.0) | UNK | 31% | UNK | UNK | 3 (30.0) | 30.0–33.3% | ||
CI, confidence interval; DM, diabetes mellitus; Dx, diagnosis; Hx, history; INR, international normalized ratio; IV, intravenous; IQR, interquartile range; LKW, last known well; mRS, modified Rankin Scale; MSU, mobile stroke unit; NIHSS, National Institutes of Health Stroke Scale; RCT, randomized clinical trial; SD, standard deviation; STEMO, stroke emergency mobile; TIA, transient ischemic attack; tPA, tissue plasminogen activator; UNK, unknown.
a
First published data from the Mercy Health MSU's first 6 months of operation.
b
Mean (SD).
c
One patient missing.
d
Mean (SD), median (IQR).