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Latest Trial Results from BEST-MSU
Mobile Stroke Units (MSUs) provide pre-hospital stroke treatment vs EMS transport and subsequent treatment in the ED. BEST-MSU is a prospective trial comparing MSU to EMS management on alternate weeks in patients with suspected acute stroke within 4.5 hrs of onset. Primary outcome was the utility-weighted modified Rankin scale (uw-mRS, range 0 to 1, higher score representing better outcome). The main analysis was of dichotomized uw-mRS >/= 0.91 vs < 0.91 (equivalent to mRS </=1 vs > 1) at 90 days in patients adjudicated tPA-eligible.
We enrolled 1,515 patients at 7 U.S. cities. 617 MSU and 430 EMS patients were tPA-eligible. Median time (min) from stroke onset to tPA was 72 MSU vs 108 EMS; 33% of tPA-eligible MSU pts were treated within 60 min of onset vs 3% EMS. 97% of tPA-eligible MSU patients actually received tPA vs 80% with EMS. Mean 90-day uw-mRS for tPA-eligible patients was 0.72 vs 0.66 for MSU vs EMS (adjusted odds ratio [OR] for MSU vs EMS of uw-mRS >/= 0.91, 2.43; 95% CI, 1.75 to 3.36; p < 0.001). The proportions of tPA-eligible patients achieving mRS of 0 or 1 at 90 days was 55% for MSU vs 44% for EMS. For all enrolled patients mean discharge uw-mRS was 0.57 vs 0.51 for MSU vs EMS (OR, 1.82; 95% CI, 1.39 to 2.37; p< 0.001). All secondary outcomes also favored MSU.
In tPA-eligible acute stroke patients, MSU management resulted in faster and more frequent tPA treatment, and less disability at 90 days.