Davis Nicolle W, Fayed Mahmoud, Hardee Evan, Lykens David, Hester Jeannette M, Magnuson Ashley E, Singh Amita, Peng Teng J, Khanna Anna
Department of Nursing and Patient Services, UF Health Shands Hospital, Comprehensive Stroke Center, Gainesville, FL (N.W.D., E.H., D.L., J.M.H., A.E.M.).
Department of Neurology, College of Medicine, University of Florida, Gainesville (M.F., A.S., T.J.P., A.K.).
Stroke. 2025 Mar;56(3):741-744. doi: 10.1161/STROKEAHA.124.048633. Epub 2025 Jan 30.
Mobile stroke units, also sometimes called Mobile Stroke Treatment Units (MSTUs) are changing the paradigm of acute stroke care and are considered to be an extension of the time is brain concept. Of the <20 active Mobile Stroke Programs in the United States, most are rooted in urban settings. In July 2023, the first MSTU in Florida was launched in Alachua County, implementing a unique and innovative rendezvous process with rural emergency medical services (EMS). We compared stroke outcome metrics between the MSTU, including rendezvous patients, and the standard process of EMS to the emergency department (ED).
We performed a retrospective analysis of patients with acute stroke evaluated in the MSTU and those transported to the ED by the standard EMS stroke alert process at an academic Comprehensive Stroke Center between July 25, 2023 and May 31, 2024. Patient demographic and acute stroke metrics were extracted to complete univariate and multivariate logistic regression analysis.
Across all 3 groups, both MSTU patients with (n=76) and without (n=291) rendezvous compared with EMS-to-ED patients (n=807), had significantly shorter mean dispatch-to-door times (29.4 versus 28.5 versus 73.2 minutes, respectively; <0.01), dispatch-to-needle times (41.3 versus 44.6 versus 104.1 minutes, respectively; <0.01), and dispatch-to-puncture (92.7 versus 81.9 versus 138.0 minutes, respectively; <0.01). In rural counties, MSTU rendezvous patients (n=76) compared with EMS-to-ED patients (n=206), had shorter mean dispatch-to-door and dispatch-to-needle times (41.3 versus 97.8 minutes, respectively; <0.001). After adjusting for age and sex, these differences remained significant (odds ratio, 1.21 [95% CI, 1.07-1.37]; <0.01 and odds ratio, 1.80 [95% CI, 1.07-3.04]; =0.03, respectively).
Our study demonstrates the effectiveness of MSTUs in Florida and establishes that the MSTU rendezvous process significantly improves timely stroke care in underserved rural counties.
移动卒中单元，有时也被称为移动卒中治疗单元（MSTU），正在改变急性卒中护理的模式，并且被认为是“时间就是大脑”这一理念的延伸。在美国现有的不到20个活跃的移动卒中项目中，大多数都扎根于城市环境。2023年7月，佛罗里达州的首个MSTU在阿拉楚阿县启动，与农村紧急医疗服务（EMS）实施了独特且创新的会合流程。我们比较了MSTU（包括会合患者）与EMS将患者送往急诊科（ED）的标准流程之间的卒中结局指标。
我们对2023年7月25日至2024年5月31日期间在一家学术性综合卒中中心接受MSTU评估的急性卒中患者以及通过标准EMS卒中警报流程送往ED的患者进行了回顾性分析。提取患者人口统计学和急性卒中指标以完成单变量和多变量逻辑回归分析。
在所有3组中，与EMS送往ED的患者（n = 807）相比，MSTU有会合（n = 76）和无会合（n = 291）的患者平均调度到门时间（分别为29.4分钟、28.5分钟和73.2分钟；<0.01）、调度到穿刺时间（分别为41.3分钟、44.6分钟和104.1分钟；<0.01）以及调度到穿刺时间（分别为92.7分钟、81.9分钟和13,8.0分钟；<0.01）均显著更短。在农村县，与EMS送往ED的患者（n = 206）相比，MSTU会合患者（n = 76）的平均调度到门和调度到穿刺时间更短（分别为41.3分钟和97.8分钟；<0.001）。在调整年龄和性别后，这些差异仍然显著（优势比分别为1.21 [95% CI，1.07 - 1.37]；<0.01和优势比为1.80 [95% CI，1.（07 - 3.04]；=0.03）。
我们的研究证明了佛罗里达州MSTU的有效性，并确定MSTU会合流程显著改善了服务不足的农村县的及时卒中护理。
