| Autor: |
Kummer BR; Department of Neurology Icahn School of Medicine at Mount Sinai New York NY., Lerario MP; Department of Neurology NewYork-Presbyterian Queens Flushing NY.; Department of Neurology Weill Cornell Medicine New York NY.; Clinical Translational Neuroscience Unit Feil Family Brain & Mind Research Institute Weill Cornell Medicine New York NY., Hunter MD; Columbia University College of Physicians & Surgeons New York NY., Wu X; Department of Healthcare Policy and Research Weill Cornell Medicine New York NY., Efraim ES; Department of Neurology Weill Cornell Medicine New York NY., Salehi Omran S; Department of Neurology Weill Cornell Medicine New York NY.; Clinical Translational Neuroscience Unit Feil Family Brain & Mind Research Institute Weill Cornell Medicine New York NY., Chen ML; Clinical Translational Neuroscience Unit Feil Family Brain & Mind Research Institute Weill Cornell Medicine New York NY., Diaz IL; Department of Healthcare Policy and Research Weill Cornell Medicine New York NY., Sacchetti D; Department of Neurology Brown Alpert School of Medicine Providence RI., Lekic T; Desert Neurology & Sleep La Quinta CA., Kulick ER; School of Public Health Brown University Providence RI., Pishanidar S; Department of Neurology NewYork-Presbyterian Queens Flushing NY.; Department of Neurology Weill Cornell Medicine New York NY.; Clinical Translational Neuroscience Unit Feil Family Brain & Mind Research Institute Weill Cornell Medicine New York NY., Mir SA; Department of Neurology Weill Cornell Medicine New York NY.; Clinical Translational Neuroscience Unit Feil Family Brain & Mind Research Institute Weill Cornell Medicine New York NY., Zhang Y; New York University Winthrop Hospital Mineola NY., Asaeda G; Fire Department of New York New York NY., Navi BB; Department of Neurology Weill Cornell Medicine New York NY.; Clinical Translational Neuroscience Unit Feil Family Brain & Mind Research Institute Weill Cornell Medicine New York NY., Marshall RS; Department of Neurology Columbia College of Physicians & Surgeons New York NY., Fink ME; Department of Neurology Weill Cornell Medicine New York NY. |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of the American Heart Association [J Am Heart Assoc] 2019 Dec 17; Vol. 8 (24), pp. e013529. Date of Electronic Publication: 2019 Dec 04. |
| DOI: |
10.1161/JAHA.119.013529 |
| Abstrakt: |
Background Mobile stroke units (MSUs) reduce time to intravenous thrombolysis in acute ischemic stroke. Whether this advantage exists in densely populated urban areas with many proximate hospitals is unclear. Methods and Results We evaluated patients from the METRONOME (Metropolitan New York Mobile Stroke) registry with suspected acute ischemic stroke who were transported by a bi-institutional MSU operating in Manhattan, New York, from October 2016 to September 2017. The comparison group included patients transported to our hospitals via conventional ambulance for acute ischemic stroke during the same hours of MSU operation (Monday to Friday, 9 am to 5 pm). Our exposure was MSU care, and our primary outcome was dispatch-to-thrombolysis time. We estimated mean differences in the primary outcome between both groups, adjusting for clinical, demographic, and geographic factors, including numbers of nearby designated stroke centers and population density. We identified 66 patients treated or transported by MSU and 19 patients transported by conventional ambulance. Patients receiving MSU care had significantly shorter dispatch-to-thrombolysis time than patients receiving conventional care (mean: 61.2 versus 91.6 minutes; P =0.001). Compared with patients receiving conventional care, patients receiving MSU care were significantly more likely to be picked up closer to a higher mean number of designated stroke centers in a 2.0-mile radius (4.8 versus 2.7, P =0.002). In multivariable analysis, MSU care was associated with a mean decrease in dispatch-to-thrombolysis time of 29.7 minutes (95% CI, 6.9-52.5) compared with conventional care. Conclusions In a densely populated urban area with a high number of intermediary stroke centers, MSU care was associated with substantially quicker time to thrombolysis compared with conventional ambulance care. |
| Databáze: |
MEDLINE |
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