HealthDay News — For patients within 4.5 hours after onset of acute stroke symptoms who are eligible for tissue plasminogen activator (t-PA), outcomes are better with treatment with mobile stroke units (MSUs) than standard management by emergency medical services (EMS), according to a study published in the Sept. 9 issue of the New England Journal of Medicine.

James C. Grotta, M.D., from the Memorial Hermann Hospital-Texas Medical Center in Houston, and colleagues examined outcomes from MSU or EMS management within 4.5 hours after onset of acute stroke symptoms. Overall, 1,047 patients were eligible to receive t-PA: 617 and 430 received care via MSU and EMS, respectively.

The researchers found that the median time from stroke onset to administration of t-PA was 72 and 108 minutes in the MSU and EMS groups, respectively; of those eligible for t-PA, 97.1 and 79.5 percent, respectively, received t-PA. Among patients eligible for t-PA, the mean score on the utility-weighted modified Rankin scale at 90 days was 0.72 and 0.66 in the MSU and EMS groups, respectively (adjusted odds ratio for a score of ≥0.91, 2.43). Overall, 55.0 and 44.4 percent, respectively, of the MSU and EMS groups who were eligible for t-PA had a score of 0 or 1 on the modified Rankin scale at 90 days.


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“Although stroke-specific emergency medical service vehicles and staff are expensive, the societal and financial burdens that are associated with untreated stroke are sufficient for social pressure to build to introduce mobile stroke units more widely,” writes the author of the accompanying editorial.

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