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Benefits of stroke treatment delivered using a mobile stroke unit trial.

Authors :
Yamal JM
Rajan SS
Parker SA
Jacob AP
Gonzalez MO
Gonzales NR
Bowry R
Barreto AD
Wu TC
Lairson DR
Persse D
Tilley BC
Chiu D
Suarez JI
Jones WJ
Alexandrov A
Grotta JC
Source :
International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2018 Apr; Vol. 13 (3), pp. 321-327. Date of Electronic Publication: 2017 Jun 14.
Publication Year :
2018

Abstract

Rationale Mobile stroke units speed treatment for acute ischemic stroke, thereby possibly improving outcomes. Aim To compare mobile stroke unit and standard management clinical outcomes, healthcare utilization, and cost-effectiveness in tissue plasminogen activator-eligible acute ischemic stroke patients calling 911. Sample size 693. Eighty percent power with 0.05 type I error rate to detect a difference of 0.09 in mean utility-weighted modified Rankin scale between groups. Design Phase III, multicenter, prospective cluster-randomized (mobile stroke unit versus standard management weeks) comparative effectiveness study in tissue plasminogen activator-eligible patients. Outcomes Primary: Ninety-day mean utility-weighted modified Rankin scale. Coprimary: cost-effectiveness based on EQ5D quality of life and one year poststroke costs. Analysis Two-sample t-test and linear regression adjusting for covariates; incremental cost-effectiveness ratio and net benefit regression. Results As of March 2017, 288 tissue plasminogen activator-eligible patients have been enrolled (173 in the mobile stroke unit arm and 115 in the standard management arm). Two new centers start in early 2017 with target end of recruitment September 2019. Conclusion This is the first randomized study to test for disability, healthcare utilization, and cost-effectiveness of a mobile stroke unit. The progress of the study suggests that it is feasible. Management of tissue plasminogen activator eligible acute ischemic stroke patients by a mobile stroke unit could potentially result in less disability and healthcare utilization, and be cost effective. Mobile stroke units are very costly. This trial may determine if the fixed cost can be justified by a reduction in disability and healthcare utilization. Clinical Trial Registration NCT02190500.

Details

Language :
English
ISSN :
1747-4949
Volume :
13
Issue :
3
Database :
MEDLINE
Journal :
International journal of stroke : official journal of the International Stroke Society
Publication Type :
Academic Journal
Accession number :
28612680
Full Text :
https://doi.org/10.1177/1747493017711950