What Have We Learned About Mobile Stroke Units?

To date, not much.  We’ve learned it’s physically possible to put a CT scanner in van.  It’s technically feasible to infuse an expensive medication into a vein.  A small amount of time is saved.

The presumption is, the few minutes saved, cumulatively, will outweigh any harms associated with the lack of evaluation in a comprehensive center by a fully-trained Emergency Physician.  And, this study – BEST-MSU – aims to measure this, comparing patient outcomes in a week-on/week-off fashion.

This is their initial report, covering a 10-week run-in phase.  During this time, the MSU was in service for 57 of those days – and there were 130 activations, or, approximately 2.7 per day.  Those activations resulted in 24 patients who were potentially eligible for the study.  Of those, 12 were treated with tPA pre-hospital.  And one of those had a non-stroke final diagnosis.

So, 130 activations for “appropriate” 11 administrations of tPA.

As the authors correctly report, very little can be concluded regarding the effectiveness of the therapy.  What does seem to be clear – this is a substantial resource expenditure associated with repeated deployments for the smallest handful of treatment eligible individuals.

“Benefits of Stroke Treatment Using a Mobile Stroke Unit Compared With Standard Management – The BEST-MSU Study Run-In Phase”
http://www.ncbi.nlm.nih.gov/pubmed/26508753