NYMC Faculty Publications

Mobile Stroke Units in Acute Ischemic Stroke: A Comprehensive Systematic Review and Meta-Analysis of 5 "T Letter" Domains

Abdulrahman Ibrahim Hagrass, From the Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Sarah Makram Elsayed, Faculty of Medicine, October 6 University, Giza, Egypt.
Mohamed Fahmy Doheim, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Mohamed Abdelhady Mostafa, Department of Neurology, University of Texas Houston McGovern Medical School, Houston, TX.
Mohamed Elfil, Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE.
Mohammed Al-Kafarna, Faculty of Pharmacy, Al-Azhar University - Gaza, Gaza Strip, Palestine.
Bashar Khaled Almaghary, Faculty of Pharmacy, Al-Azhar University - Gaza, Gaza Strip, Palestine.
Aya Mamdouh Fayoud, Faculty of Pharmacy, Kafr El-Shaikh University, Kafr El-Shaikh, Egypt.
Aboalmagd Hamdallah, Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
Mohammed Tarek Hasan, From the Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Khaled Mohamed Ragab, Faculty of Medicine, Minia University, Minia, Egypt.
Anas Zakarya Nourelden, From the Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Mohamed Sayed Zaazouee, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
Chaitanya Medicherla, Department of Neurology, Westchester Medical Center, Valhalla, NY.
Mackenzie Lerario, Department of Neurology, Weill Cornell Medical College, New York, NY.
Alexandra L. Czap, Department of Neurology, University of Texas Houston McGovern Medical School, Houston, TX.
Ji Chong, Department of Neurology, Westchester Medical Center, Valhalla, NY.
May Nour, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Fawaz Al-Mufti, Departments of Neurology and Neurosurgery, New York Medical College at Westchester Medical Center, Valhalla, NY.Follow

Author Type(s)

Faculty

DOI

10.1097/CRD.0000000000000699

Journal Title

Cardiology in Review

First Page

297

Last Page

313

Document Type

Article

Publication Date

7-1-2024

Department

Neurology

Abstract

Intravenous thrombolysis (IVT) may be administered to stroke patients requiring immediate treatment more quickly than emergency medical services if certain conditions are met. These conditions include the presence of mobile stroke units (MSUs) with on-site treatment teams and a computed tomography scanner. We compared clinical outcomes of MSU conventional therapy by emergency medical services through a systematic review and meta-analysis. We searched key electronic databases from inception till September 2021. The primary outcomes were mortality at 7 and 90 days. The secondary outcomes included the modified Rankin Scale score at 90 days, alarm to IVT or intra-arterial recanalization, and time from symptom onset or last known well to thrombolysis. We included 19 controlled trials and cohort studies to conduct our final analysis. Our comparison revealed that 90-day mortality significantly decreased in the MSU group compared with the conventional care group [risk ratio = 0.82; 95% confidence interval (CI), 0.71-0.95], while there was no significant difference at 7 days (risk ratio = 0.89; 95% CI, 0.69-1.15). MSU achieved greater functional independence (modified Rankin Scale = 0-2) at 90 days (risk ratio = 1.08; 95% CI, 1.01-1.16). MSU was associated with shorter alarm to IVT or intra-arterial recanalization time (mean difference = -29.69; 95% CI, -34.46 to -24.92), treating patients in an earlier time window, as shown through symptom onset or last known well to thrombolysis (mean difference = -36.79; 95% CI, -47.48 to -26.10). MSU-treated patients had a lower rate of 90-day mortality and better 90-day functional outcomes by earlier initiation of IVT compared with conventional care.

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