TY - JOUR
T1 - Outcomes of patients with pre-existing disability managed by mobile stroke units
T2 - A sub-analysis of the BEST-MSU study
AU - Pirlog, Bianca O.
AU - Jacob, Asha P.
AU - Rajan, Suja S.
AU - Yamal, Jose Miguel
AU - Parker, Stephanie A.
AU - Wang, Mengxi
AU - Bowry, Ritvij
AU - Czap, Alexandra
AU - Bratina, Patti L.
AU - Gonzalez, Michael O.
AU - Singh, Noopur
AU - Zou, Jinhao
AU - Gonzales, Nicole R.
AU - Jones, William J.
AU - Alexandrov, Anne W.
AU - Alexandrov, Andrei V.
AU - Navi, Babak B.
AU - Nour, May
AU - Spokoyny, Ilana
AU - Mackey, Jason
AU - Silnes, Kelly
AU - Fink, Matthew E.
AU - Pisarro Sherman, Carla
AU - Willey, Josh
AU - Saver, Jeffrey L.
AU - English, Joey
AU - Barazangi, Nobl
AU - Ornelas, David
AU - Volpi, Jay
AU - PV Rao, Chethan
AU - Griffin, Laura
AU - Persse, David
AU - Grotta, James C.
N1 - Publisher Copyright:
© 2023 World Stroke Organization.
PY - 2023/12
Y1 - 2023/12
N2 - Background: Few data exist on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. A recent trial of mobile stroke units (MSUs) demonstrated faster treatment and improved outcomes, and included PD patients. Aim: To determine outcomes with tissue plasminogen activator (tPA), and benefit of MSU versus management by emergency medical services (EMS), for PD patients. Methods: Primary outcomes were utility-weighted modified Rankin Scale (uw-mRS). Linear and logistic regression models compared outcomes in patients with versus without PD, and PD patients treated by MSU versus standard management by EMS. Time metrics, safety, quality of life, and health-care utilization were compared. Results: Of the 1047 tPA-eligible ischemic stroke patients, 254 were with PD (baseline mRS 2–5) and 793 were without PD (baseline mRS 0–1). Although PD patients had worse 90-day uw-mRS, higher mortality, more health-care utilization, and worse quality of life than non-disabled patients, 53% returned to at least their baseline mRS, those treated faster had better outcome, and there was no increased bleeding risk. Comparing PD patients treated by MSU versus EMS, 90-day uw-mRS was 0.42 versus 0.36 (p = 0.07) and 57% versus 46% returned to at least their baseline mRS. There was no interaction between disability status and MSU versus EMS group assignment (p = 0.67) for 90-day uw-mRS. Conclusion: PD did not prevent the benefit of faster treatment with tPA in the BEST-MSU study. Our data support inclusion of PD patients in the MSU management paradigm.
AB - Background: Few data exist on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. A recent trial of mobile stroke units (MSUs) demonstrated faster treatment and improved outcomes, and included PD patients. Aim: To determine outcomes with tissue plasminogen activator (tPA), and benefit of MSU versus management by emergency medical services (EMS), for PD patients. Methods: Primary outcomes were utility-weighted modified Rankin Scale (uw-mRS). Linear and logistic regression models compared outcomes in patients with versus without PD, and PD patients treated by MSU versus standard management by EMS. Time metrics, safety, quality of life, and health-care utilization were compared. Results: Of the 1047 tPA-eligible ischemic stroke patients, 254 were with PD (baseline mRS 2–5) and 793 were without PD (baseline mRS 0–1). Although PD patients had worse 90-day uw-mRS, higher mortality, more health-care utilization, and worse quality of life than non-disabled patients, 53% returned to at least their baseline mRS, those treated faster had better outcome, and there was no increased bleeding risk. Comparing PD patients treated by MSU versus EMS, 90-day uw-mRS was 0.42 versus 0.36 (p = 0.07) and 57% versus 46% returned to at least their baseline mRS. There was no interaction between disability status and MSU versus EMS group assignment (p = 0.67) for 90-day uw-mRS. Conclusion: PD did not prevent the benefit of faster treatment with tPA in the BEST-MSU study. Our data support inclusion of PD patients in the MSU management paradigm.
KW - Acute stroke therapy
KW - clinical trial
KW - ischemic stroke
KW - mobile stroke unit
KW - pre-existing disability
KW - tPA
KW - Humans
KW - Fibrinolytic Agents/therapeutic use
KW - Treatment Outcome
KW - Clinical Trials as Topic
KW - Stroke/drug therapy
KW - Tissue Plasminogen Activator/therapeutic use
KW - Quality of Life
KW - Emergency Medical Services
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U2 - 10.1177/17474930231185471
DO - 10.1177/17474930231185471
M3 - Article
C2 - 37337357
AN - SCOPUS:85164529500
SN - 1747-4930
VL - 18
SP - 1209
EP - 1218
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - 10
ER -