Abstract 167: Geographic Analysis of Mobile Stroke Unit Treatment in a Densely Populated Urban Area: The New York City METRONOME Registry
| Autor: | Randolph S. Marshall, Glenn Asaeda, Tim Lekic, Matthew E. Fink, Madeleine D Hunter, Elizabeth S Efraim, Sammy Pishanidar, Xian Wu, Yi Zhang, Erin R. Kulick, Saad Mir, Michael P Lerario, Benjamin R Kummer, Iván Díaz, Daniel Sacchetti, Babak B. Navi, Setareh Salehi Omran |
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| Rok vydání: | 2019 |
| Předmět: |
Advanced and Specialized Nursing
geography medicine.medical_specialty geography.geographical_feature_category Thrombolytic treatment business.industry Stroke units Metronome 030204 cardiovascular system & hematology Urban area medicine.disease law.invention Unit (housing) 03 medical and health sciences 0302 clinical medicine law Geographic analysis Emergency medicine Medicine Neurology (clinical) Cardiology and Cardiovascular Medicine business Acute ischemic stroke Stroke 030217 neurology & neurosurgery |
| Zdroj: | Stroke. 50 |
| ISSN: | 1524-4628 0039-2499 |
| Popis: | Background: Mobile stroke units (MSUs) reduce time to thrombolytic treatment in acute ischemic stroke. It is unclear whether this time advantage persists in densely-populated urban areas with many readily-accessible hospitals. Methods: We collected clinical data, treatment times, numbers of nearby designated stroke centers (DSC), and distances traveled from suspected stroke patients transported by a single-institution MSU operating in Manhattan, New York from October 2016-September 2017. For comparison, we collected information on patients transported to our institution via conventional ambulance for acute stroke during the same hours of MSU operation (Monday-Friday, 9AM-5PM). Our exposure was MSU care, and our coprimary outcomes were dispatch-to-scene arrival and scene arrival-to-thrombolysis times. We estimated mean differences in each primary outcome between both groups, adjusting for clinical, demographic, and geographic factors. Results: We identified 66 patients transported by MSU, of whom 29 (44%) were treated with IV thrombolysis, and 19 patients transported by conventional ambulance, of whom 9 (48%) were treated with IV thrombolysis. Patients treated in the MSU traveled longer to accepting hospitals and were picked up closer to a greater number of DSCs in a 1 mile radius than non-MSU patients (Table). Despite longer median dispatch-to-ambulance arrival and ambulance arrival-to-hospital arrival times than non-MSU patients, MSU patients had shorter mean dispatch-to-thrombolysis and ambulance arrival-to-thrombolysis times. In multivariable analysis, MSU care was associated with a mean increase in dispatch-to-ambulance arrival time of 6.5 minutes (95% CI, 2.3-10.6) that was offset by a mean decrease in ambulance arrival-to-thrombolysis time of 42.2 minutes (95% CI, 31.1-53.4). Conclusions: In a densely populated urban area, MSU care was associated with substantially quicker time-to-thrombolysis when compared to conventional care. |
| Databáze: | OpenAIRE |
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