Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond
Background Despite proven benefits, the use of single‐purpose mobile stroke units (MSUs) has raised concerns about their effective and cost‐efficient integration into clinical practice, especially when considered for operation in nonurban areas. The MSU concept may benefit from opening the indicatio...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-01-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.122.000482 |
| _version_ | 1797258520371920896 |
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| author | Klaus Fassbender Daniel J. Phillips Iris Q. Grunwald Andrea Schottek Sajid Alam Saman Perera Annie Chakrabarti Robert Moon Martin Lesmeister Viola Wagner Damon Wheddon David Dommett Brittany Wells Rheanne Middleton Robert Willis Monika Bachhuber Fatma Merzou Stefan Wagenpfeil Jineesh Thottath Thomas Bertsch Silke Walter |
| author_facet | Klaus Fassbender Daniel J. Phillips Iris Q. Grunwald Andrea Schottek Sajid Alam Saman Perera Annie Chakrabarti Robert Moon Martin Lesmeister Viola Wagner Damon Wheddon David Dommett Brittany Wells Rheanne Middleton Robert Willis Monika Bachhuber Fatma Merzou Stefan Wagenpfeil Jineesh Thottath Thomas Bertsch Silke Walter |
| author_sort | Klaus Fassbender |
| collection | DOAJ |
| description | Background Despite proven benefits, the use of single‐purpose mobile stroke units (MSUs) has raised concerns about their effective and cost‐efficient integration into clinical practice, especially when considered for operation in nonurban areas. The MSU concept may benefit from opening the indication spectrum to include frequent stroke mimics and additional emergencies. Methods The current observational study evaluated benefits for the treatment and triage decision‐making of use of an MSU with extended capabilities (Hybrid‐MSU), also including radiography, ultrasonography, extended point‐of‐care laboratory, ECG, electroencephalography, and advanced medications. Apart from patients with a dispatch code for “stroke”, the ambulance was also dispatched to those with codes for “seizures”, “falls with head trauma”, “headache”, “unconsciousness”, “infection and pandemic”, “chest pain”, and “breathing problems”. Results For 250 patients treated by the Hybrid‐MSU, but not for 250 conventionally treated patients, the prehospital diagnostic workup allowed, apart from treatment with stroke thrombolytics (n=15), prehospital administration of specific anticonvulsants (n=15), antibiotics (n=5), early secondary stroke prophylaxis with aspirin (n=49), and the Sepsis Six bundle (n=2). Prehospital diagnosis avoided 215 (86.0%) admissions to the emergency department, either by management at home (n=116, 46.4%) or by directly transferring patients to the required specialized wards (n=99, 39.6%). Conclusion The current study demonstrates the feasibility of the use of a Hybrid‐MSU and indicates its potential benefits for prehospital treatment and triage decision‐making. Opening the indication spectrum, together with an act‐alone ability, could be a key in the future integration of MSUs into routine health care. |
| first_indexed | 2024-03-08T18:28:45Z |
| format | Article |
| id | doaj.art-6a1c63d93e52443bbee793acb551f62d |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-04-24T22:54:50Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-6a1c63d93e52443bbee793acb551f62d2024-03-18T06:39:33ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-01-013110.1161/SVIN.122.000482Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and BeyondKlaus Fassbender0Daniel J. Phillips1Iris Q. Grunwald2Andrea Schottek3Sajid Alam4Saman Perera5Annie Chakrabarti6Robert Moon7Martin Lesmeister8Viola Wagner9Damon Wheddon10David Dommett11Brittany Wells12Rheanne Middleton13Robert Willis14Monika Bachhuber15Fatma Merzou16Stefan Wagenpfeil17Jineesh Thottath18Thomas Bertsch19Silke Walter20Department of Neurology Saarland University Medical Center Homburg GermanyEast of England Ambulance Service NHS Trust Melbourn UKImaging Science and Technology School of Medicine University of Dundee Dundee UKDepartment of Neurology Saarland University Medical Center Homburg GermanyEast Suffolk and North Essex NHS Foundation Trust Ipswich UKMid and South Essex NHS Foundation Trust Southend‐on‐Sea UKNorfolk and Norwich University Hospital NHS Foundation Trust Norwich UKEast of England Ambulance Service NHS Trust Melbourn UKDepartment of Neurology Saarland University Medical Center Homburg GermanyDepartment of Neurology Saarland University Medical Center Homburg GermanyEast of England Ambulance Service NHS Trust Melbourn UKMid and South Essex NHS Foundation Trust Southend‐on‐Sea UKEast of England Ambulance Service NHS Trust Melbourn UKEast of England Ambulance Service NHS Trust Melbourn UKEast of England Ambulance Service NHS Trust Melbourn UKDepartment of Neurology Saarland University Medical Center Homburg GermanyDepartment of Neurology Saarland University Medical Center Homburg GermanyInstitute for Medical Biometry Epidemiology and Medical Informatics Saarland University Campus Homburg Saarland GermanyMid and South Essex NHS Foundation Trust Southend‐on‐Sea UKInstitute of Clinical Chemistry Laboratory Medicine and Transfusion Medicine Nuremberg General Hospital Paracelsus Medical University Nuremberg GermanyDepartment of Neurology Saarland University Medical Center Homburg GermanyBackground Despite proven benefits, the use of single‐purpose mobile stroke units (MSUs) has raised concerns about their effective and cost‐efficient integration into clinical practice, especially when considered for operation in nonurban areas. The MSU concept may benefit from opening the indication spectrum to include frequent stroke mimics and additional emergencies. Methods The current observational study evaluated benefits for the treatment and triage decision‐making of use of an MSU with extended capabilities (Hybrid‐MSU), also including radiography, ultrasonography, extended point‐of‐care laboratory, ECG, electroencephalography, and advanced medications. Apart from patients with a dispatch code for “stroke”, the ambulance was also dispatched to those with codes for “seizures”, “falls with head trauma”, “headache”, “unconsciousness”, “infection and pandemic”, “chest pain”, and “breathing problems”. Results For 250 patients treated by the Hybrid‐MSU, but not for 250 conventionally treated patients, the prehospital diagnostic workup allowed, apart from treatment with stroke thrombolytics (n=15), prehospital administration of specific anticonvulsants (n=15), antibiotics (n=5), early secondary stroke prophylaxis with aspirin (n=49), and the Sepsis Six bundle (n=2). Prehospital diagnosis avoided 215 (86.0%) admissions to the emergency department, either by management at home (n=116, 46.4%) or by directly transferring patients to the required specialized wards (n=99, 39.6%). Conclusion The current study demonstrates the feasibility of the use of a Hybrid‐MSU and indicates its potential benefits for prehospital treatment and triage decision‐making. Opening the indication spectrum, together with an act‐alone ability, could be a key in the future integration of MSUs into routine health care.https://www.ahajournals.org/doi/10.1161/SVIN.122.000482mobile stroke unitprehospitalstroke |
| spellingShingle | Klaus Fassbender Daniel J. Phillips Iris Q. Grunwald Andrea Schottek Sajid Alam Saman Perera Annie Chakrabarti Robert Moon Martin Lesmeister Viola Wagner Damon Wheddon David Dommett Brittany Wells Rheanne Middleton Robert Willis Monika Bachhuber Fatma Merzou Stefan Wagenpfeil Jineesh Thottath Thomas Bertsch Silke Walter Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond Stroke: Vascular and Interventional Neurology mobile stroke unit prehospital stroke |
| title | Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond |
| title_full | Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond |
| title_fullStr | Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond |
| title_full_unstemmed | Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond |
| title_short | Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond |
| title_sort | hybrid mobile stroke unit opening the indication spectrum for stroke mimics and beyond |
| topic | mobile stroke unit prehospital stroke |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.122.000482 |
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