Abstract 34: Outcomes of Thrombolysis on Mobile Stroke Unit

Abstract

Introduction: Mobile stroke Units (MSU) can shorten the time to intravenous thrombolytic therapy (IVT) in patients with acute ischemic stroke. We aimed to demonstrate the effects of pre-hospital IVT on clinical outcomes. Methods: We reviewed patients received IVT from July 2014 to December 2017, and compared patients with pre-hospital IVT on MSU with patients brought to the ED via a conventional ambulance. The primary outcome was the modified Rankin scale score (mRS) of 1 or better at 90 days. Binary logistic regression model of 90-day mRS for 0-1 vs 2-6 was adjusted for age, initial National Institutes of Health Stroke Scale (NIHSS) score, and pre-morbid mRS. Results: Seventy eight patients were treated in the MSU and 153 patients were received IVT in the ED. There were no significant differences in gender, age, pre-morbid mRS, initial NIHSS score, and risk factors between the MSU group and the ED group. The MSU patients received thrombolysis 38 minutes earlier from onset than the ED patients (median 79 minutes compared to117 minutes, p<0.001). In an unadjusted analysis, the difference in primary outcome between MSU group and ED group was not significant (41% with MSU vs 29% with ED, p=0.061, Figure). After adjustment for age, initial NIHSS score, and pre-morbid mRS, the odds ratio for mRS of 0-1 at 90 days with IVT on MSU compared to ED for was 2.09 (95% confidence interval (CI), 1.02-4.28, p = 0.044). Further adjustment for the time from onset to thrombolytic treatment, the effect of MSU on 90-day mRS was attenuated and no longer significant (odds ratio 1.65, 95% CI, 0.77-3.55, p=0.196). Conclusion: Pre-hospital IVT on MSU compared to conventional care shortened the time to thrombolytic treatment and was associated with improved functional outcomes in patients with acute ischemic stroke.