Abstract 228: Comparative Analysis of Mobile Stroke Treatment Unit (MSTU) and Emergency Department (ED) Patients with Large Vessel Occlusion (LVO) in Need of Endovascular Thrombectomy
Authors: Saini N. , Peng T. , Davis N. W. , Lykens D. , Hester J. M. , Magnuson A. E. , Khanna A. 
Published: January 2025

Introduction

Large vessel occlusion (LVO) strokes represent a critical medical emergency requiring prompt intervention to minimize neurological damage and improve patient outcomes. Traditionally, patients with LVO are taken to the Emergency Department (ED) via standard Emergency Medical Services (EMS) before undergoing endovascular mechanical thrombectomy (MT). However, some Mobile Stroke Treatment Units (MSTUs) are introducing an alternative pathway for rapid, pre‐hospital care by taking the LVO patient directly to the Operating Room (OR), bypassing the ED all together. This study compares the outcomes of patients with LVOs admitted directly to the OR from the MSTU versus those arrived by EMS and admitted through the ED. The findings from this project will aim to inform best practice for managing LVO cases, improve patient care protocols, as well as further investigate the value of a MSTU.

Methods

This quality improvement project is a retrospective cohort analysis comparing LVO patients directly admitted to the OR from the MSTU versus the standard process of EMS‐to‐ED, excluding hospital‐to‐hospital transfers and arrival by personal vehicle. “Door” for MSTU patients is measured as the time the patient crosses the threshold of the unit. Time measurements for MSTU LVO patients include transport time to the hospital. We reviewed the records of patients with LVO treated with mechanical thrombectomy at the University of Florida between 7/25/23 and 6/30/24. Demographics, endovascular thrombectomy stroke metrics, functional outcomes, and mortality data were compared using univariate and multivariate logistic regression analyses.

Results

A total of 71 patients (mean age 72.2, 47.8% female) were included in the final analyses. 20 patients in the MSTU cohort and 51 patients in the ED cohort were evaluated. The MSTU patient cohort had a faster mean door‐to‐puncture time of 40.9 minutes compared to 65.2 minutes for the ED cohort (OR 1.10 (95%CI 1.04‐1.17), p=0.001). Similarly, the MSTU cohort also had a faster mean door‐to‐recanalization time of 62.9 minutes versus 86.4 minutes in the ED cohort (OR 1.06 (96%CI 1.02‐1.11), p=0.003). These findings remained statistically significant despite adjusting for age and sex. Patients treated on the MSTU with direct to OR also had higher odds of being discharged with favorable functional outcomes defined as mRS of 0‐2 compared to patient arriving via EMS‐to‐ED (OR 9.61 (95%C.I. 1.64‐56.4), p=0.012, adjusted for age and sex). While not statistically significant, we also found a trend towards decreased mortality with patients treated on the MSTU (p=0.09).

Conclusion

Our study demonstrates improved quality measures and outcomes for LVO stroke patients treated on a MSTU. The MSTU brings expert stroke care to the patient and allows for improved early diagnosis and intervention. With direct admission to the OR, door‐to‐puncture and door‐to‐recanalization times were significantly decreased and functional outcomes were improved as compared to those admitted through the ED via traditional EMS arrival. MSTUs are well‐positioned to enhance the efficiency and effectiveness of LVO stroke pathways by providing more timely treatment, and improving stroke systems of care and patient outcomes.