Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis
The available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to establish normalized metrics and to conduct a meta-analysis of the current literature on MSU performance. Our MSU in upstate New York serves 741,000 peopl...
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Published in | Frontiers in neurology Vol. 13; p. 868051 |
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Main Authors | , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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Frontiers Media S.A
09.05.2022
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Abstract | The available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to establish normalized metrics and to conduct a meta-analysis of the current literature on MSU performance.
Our MSU in upstate New York serves 741,000 people. We present prospectively collected, retrospectively analyzed data from the inception of our MSU in October of 2018, through March of 2021. Rates of transportation/dispatch and MSU utilization were reported. We also performed a meta-analysis using MEDLINE, SCOPUS, and Cochrane Library databases, calculating rates of tPA/dispatch, tPA-per-24-operational-hours ("per day"), mechanical thrombectomy (MT)/dispatch and MT/day.
Our MSU was dispatched 1,719 times in 606 days (8.5 dispatches/24-operational-hours) and transported 324 patients (18.8%) to the hospital. Intravenous tPA was administered in 64 patients (3.7% of dispatches) and the rate of tPA/day was 0.317 (95% CI 0.150-0.567). MT was performed in 24 patients (1.4% of dispatches) for a MT/day rate of 0.119 (95% CI 0.074-0.163). The MSU was in use for 38,742 minutes out of 290,760 total available minutes (13.3% utilization rate). Our meta-analysis included 14 articles. Eight studies were included in the analysis of tPA/dispatch (342/5,862) for a rate of 7.2% (95% CI 4.8-9.5%, I
= 92%) and 11 were included in the analysis of tPA/day (1,858/4,961) for a rate of 0.358 (95% CI 0.215-0.502, I
= 99%). Seven studies were included for MT/dispatch (102/5,335) for a rate of 2.0% (95% CI 1.2-2.8%, I
= 67%) and MT/day (103/1,249) for a rate of 0.092 (95% CI 0.046-0.138, I
= 91%).
In this single institution retrospective study and meta-analysis, we outline the following operational metrics: tPA/dispatch, tPA/day, MT/dispatch, MT/day, and utilization rate. These metrics are useful for internal and external comparison for institutions with or considering developing mobile stroke programs. |
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AbstractList | BackgroundThe available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to establish normalized metrics and to conduct a meta-analysis of the current literature on MSU performance.MethodsOur MSU in upstate New York serves 741,000 people. We present prospectively collected, retrospectively analyzed data from the inception of our MSU in October of 2018, through March of 2021. Rates of transportation/dispatch and MSU utilization were reported. We also performed a meta-analysis using MEDLINE, SCOPUS, and Cochrane Library databases, calculating rates of tPA/dispatch, tPA-per-24-operational-hours (“per day”), mechanical thrombectomy (MT)/dispatch and MT/day.ResultsOur MSU was dispatched 1,719 times in 606 days (8.5 dispatches/24-operational-hours) and transported 324 patients (18.8%) to the hospital. Intravenous tPA was administered in 64 patients (3.7% of dispatches) and the rate of tPA/day was 0.317 (95% CI 0.150–0.567). MT was performed in 24 patients (1.4% of dispatches) for a MT/day rate of 0.119 (95% CI 0.074–0.163). The MSU was in use for 38,742 minutes out of 290,760 total available minutes (13.3% utilization rate). Our meta-analysis included 14 articles. Eight studies were included in the analysis of tPA/dispatch (342/5,862) for a rate of 7.2% (95% CI 4.8–9.5%, I2 = 92%) and 11 were included in the analysis of tPA/day (1,858/4,961) for a rate of 0.358 (95% CI 0.215–0.502, I2 = 99%). Seven studies were included for MT/dispatch (102/5,335) for a rate of 2.0% (95% CI 1.2–2.8%, I2 = 67%) and MT/day (103/1,249) for a rate of 0.092 (95% CI 0.046–0.138, I2 = 91%).ConclusionsIn this single institution retrospective study and meta-analysis, we outline the following operational metrics: tPA/dispatch, tPA/day, MT/dispatch, MT/day, and utilization rate. These metrics are useful for internal and external comparison for institutions with or considering developing mobile stroke programs. The available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to establish normalized metrics and to conduct a meta-analysis of the current literature on MSU performance. Our MSU in upstate New York serves 741,000 people. We present prospectively collected, retrospectively analyzed data from the inception of our MSU in October of 2018, through March of 2021. Rates of transportation/dispatch and MSU utilization were reported. We also performed a meta-analysis using MEDLINE, SCOPUS, and Cochrane Library databases, calculating rates of tPA/dispatch, tPA-per-24-operational-hours ("per day"), mechanical thrombectomy (MT)/dispatch and MT/day. Our MSU was dispatched 1,719 times in 606 days (8.5 dispatches/24-operational-hours) and transported 324 patients (18.8%) to the hospital. Intravenous tPA was administered in 64 patients (3.7% of dispatches) and the rate of tPA/day was 0.317 (95% CI 0.150-0.567). MT was performed in 24 patients (1.4% of dispatches) for a MT/day rate of 0.119 (95% CI 0.074-0.163). The MSU was in use for 38,742 minutes out of 290,760 total available minutes (13.3% utilization rate). Our meta-analysis included 14 articles. Eight studies were included in the analysis of tPA/dispatch (342/5,862) for a rate of 7.2% (95% CI 4.8-9.5%, I = 92%) and 11 were included in the analysis of tPA/day (1,858/4,961) for a rate of 0.358 (95% CI 0.215-0.502, I = 99%). Seven studies were included for MT/dispatch (102/5,335) for a rate of 2.0% (95% CI 1.2-2.8%, I = 67%) and MT/day (103/1,249) for a rate of 0.092 (95% CI 0.046-0.138, I = 91%). In this single institution retrospective study and meta-analysis, we outline the following operational metrics: tPA/dispatch, tPA/day, MT/dispatch, MT/day, and utilization rate. These metrics are useful for internal and external comparison for institutions with or considering developing mobile stroke programs. Background The available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to establish normalized metrics and to conduct a meta-analysis of the current literature on MSU performance. Methods Our MSU in upstate New York serves 741,000 people. We present prospectively collected, retrospectively analyzed data from the inception of our MSU in October of 2018, through March of 2021. Rates of transportation/dispatch and MSU utilization were reported. We also performed a meta-analysis using MEDLINE, SCOPUS, and Cochrane Library databases, calculating rates of tPA/dispatch, tPA-per-24-operational-hours (“per day”), mechanical thrombectomy (MT)/dispatch and MT/day. Results Our MSU was dispatched 1,719 times in 606 days (8.5 dispatches/24-operational-hours) and transported 324 patients (18.8%) to the hospital. Intravenous tPA was administered in 64 patients (3.7% of dispatches) and the rate of tPA/day was 0.317 (95% CI 0.150–0.567). MT was performed in 24 patients (1.4% of dispatches) for a MT/day rate of 0.119 (95% CI 0.074–0.163). The MSU was in use for 38,742 minutes out of 290,760 total available minutes (13.3% utilization rate). Our meta-analysis included 14 articles. Eight studies were included in the analysis of tPA/dispatch (342/5,862) for a rate of 7.2% (95% CI 4.8–9.5%, I 2 = 92%) and 11 were included in the analysis of tPA/day (1,858/4,961) for a rate of 0.358 (95% CI 0.215–0.502, I 2 = 99%). Seven studies were included for MT/dispatch (102/5,335) for a rate of 2.0% (95% CI 1.2–2.8%, I 2 = 67%) and MT/day (103/1,249) for a rate of 0.092 (95% CI 0.046–0.138, I 2 = 91%). Conclusions In this single institution retrospective study and meta-analysis, we outline the following operational metrics: tPA/dispatch, tPA/day, MT/dispatch, MT/day, and utilization rate. These metrics are useful for internal and external comparison for institutions with or considering developing mobile stroke programs. |
Author | Bender, Matthew T Pilcher, Webster H Bhalla, Tarun Rahmani, Redi Mattingly, Thomas K Ellens, Nathaniel R Proper, Diana Akkipeddi, Sajal Medha K Kelly, Adam G Parker, Stephanie A Burgett, Jason L Grotta, James C Schartz, Derrek Benesch, Curtis G |
AuthorAffiliation | 2 Department of Imaging Sciences, University of Rochester Medical Center , Rochester, NY , United States 3 Department of Neurology, University of Rochester Medical Center , Rochester, NY , United States 4 Department of Neurology, University of Texas McGovern Medical School , Houston, TX , United States 5 Mobile Stroke Unit, Memorial Hermann Hospital—Texas Medical Center , Houston, TX , United States 1 Department of Neurosurgery, University of Rochester Medical Center , Rochester, NY , United States |
AuthorAffiliation_xml | – name: 1 Department of Neurosurgery, University of Rochester Medical Center , Rochester, NY , United States – name: 2 Department of Imaging Sciences, University of Rochester Medical Center , Rochester, NY , United States – name: 4 Department of Neurology, University of Texas McGovern Medical School , Houston, TX , United States – name: 5 Mobile Stroke Unit, Memorial Hermann Hospital—Texas Medical Center , Houston, TX , United States – name: 3 Department of Neurology, University of Rochester Medical Center , Rochester, NY , United States |
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CitedBy_id | crossref_primary_10_1161_SVIN_123_001051 crossref_primary_10_3389_fneur_2024_1358145 crossref_primary_10_1111_ene_16298 |
Cites_doi | 10.1161/STROKEAHA.115.011093 10.1001/jama.2014.2850 10.1111/jon.12276 10.1161/01.STR.0000075573.22885.3B 10.1161/STROKEAHA.119.027843 10.1001/jama.2020.26345 10.1161/STROKEAHA.120.033576 10.1016/S1474-4422(12)70057-1 10.1136/svn-2021-001119 10.1038/s41598-021-84441-0 10.3389/fneur.2018.00283 10.1111/ene.14877 10.1161/JAHA.119.013529 10.1016/S1474-4422(16)30129-6 10.1056/NEJMe2111028 10.1212/WNL.0000000000003786 10.1159/000487334 10.1097/MCC.0000000000000702 10.1001/jamaneurol.2015.3849 10.1056/NEJMoa2103879 10.1159/000508910 10.1016/j.clineuro.2020.106155 10.1161/STROKEAHA.119.024950 |
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Copyright | Copyright © 2022 Ellens, Schartz, Rahmani, Akkipeddi, Kelly, Benesch, Parker, Burgett, Proper, Pilcher, Mattingly, Grotta, Bhalla and Bender. Copyright © 2022 Ellens, Schartz, Rahmani, Akkipeddi, Kelly, Benesch, Parker, Burgett, Proper, Pilcher, Mattingly, Grotta, Bhalla and Bender. 2022 Ellens, Schartz, Rahmani, Akkipeddi, Kelly, Benesch, Parker, Burgett, Proper, Pilcher, Mattingly, Grotta, Bhalla and Bender |
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Keywords | tissue plasminogen activator (tPA) operational performance ambulance mobile stroke unit (MSU) mechanical thrombectomy (MT) |
Language | English |
License | Copyright © 2022 Ellens, Schartz, Rahmani, Akkipeddi, Kelly, Benesch, Parker, Burgett, Proper, Pilcher, Mattingly, Grotta, Bhalla and Bender. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Edited by: Sheila Cristina Ouriques Martins, Hospital Moinhos de Vento, Brazil Reviewed by: Andrea Zini, IRCCS Institute of Neurological Sciences of Bologna (ISNB), Italy; Alberto Maud, Texas Tech University Health Sciences Center El Paso, United States This article was submitted to Stroke, a section of the journal Frontiers in Neurology |
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References | Bowry (B14) 2015; 46 Cerejo (B19) 2015; 25 Ebinger (B9) 2021; 325 Zhao (B4) 2020; 51 Ebinger (B2) 2014; 311 Freitag (B11) 2021; 52 Grotta (B8) 2021; 385 Weinberg (B17) 2020; 198 Larsen (B18) 2021; 28 Calderon (B22) 2018; 7 Kate (B13) 2021; 11 Grunwald (B23) 2020; 49 Kunz (B20) 2016; 15 Zaidat (B21) 2019; 50 Itrat (B5) 2016; 73 Walter (B6) 2012; 11 Taqui (B15) 2017; 88 Bhalla (B12) 2020; 26 Lees (B10) 2021; 385 Kummer (B3) 2019; 8 Bender (B7) 2021; 2021 Fassbender (B1) 2003; 34 Lin (B16) 2018; 9 |
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Snippet | The available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to establish... Background The available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to... BackgroundThe available literature on mobile stroke units (MSU) has focused on clinical outcomes, rather than operational performance. Our objective was to... |
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StartPage | 868051 |
SubjectTerms | ambulance mechanical thrombectomy (MT) mobile stroke unit (MSU) Neurology operational performance tissue plasminogen activator (tPA) |
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Title | Mobile Stroke Unit Operational Metrics: Institutional Experience, Systematic Review and Meta-Analysis |
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