Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond

Abstract

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.