دورية أكاديمية
Outcomes of patients with pre-existing disability managed by mobile stroke units: A sub-analysis of the BEST-MSU study.
| العنوان: | Outcomes of patients with pre-existing disability managed by mobile stroke units: A sub-analysis of the BEST-MSU study. |
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| المؤلفون: | Pirlog BO; Department of Neuroscience, County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania., Jacob AP; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA., Rajan SS; Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA., Yamal JM; Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA., Parker SA; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA., Wang M; Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA., Bowry R; Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA., Czap A; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA., Bratina PL; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA., Gonzalez MO; Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA., Singh N; Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA., Zou J; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Gonzales NR; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Jones WJ; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Alexandrov AW; Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA., Alexandrov AV; Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA., Navi BB; Feil Family and Brain Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA., Nour M; Department of Neurology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, CA, USA., Spokoyny I; Department of Neurology, Mills-Peninsula Medical Center, Burlingame, CA, USA., Mackey J; Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA., Silnes K; University of Buckingham Medical School, Buckingham, UK., Fink ME; Feil Family and Brain Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA., Pisarro Sherman C; Feil Family and Brain Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA., Willey J; Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA., Saver JL; Department of Neurology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, CA, USA., English J; Department of Neurology, Mills-Peninsula Medical Center, Burlingame, CA, USA., Barazangi N; Department of Neurology, Mills-Peninsula Medical Center, Burlingame, CA, USA., Ornelas D; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Volpi J; Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA., Pv Rao C; Department of Neurology, Baylor College of Medicine, Houston, TX, USA., Griffin L; HCA Houston Healthcare, Houston, TX, USA., Persse D; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA., Grotta JC; Mobile Stroke Unit, Memorial Hermann Texas Medical Center, Houston, TX, USA. |
| المصدر: | International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2023 Dec; Vol. 18 (10), pp. 1209-1218. Date of Electronic Publication: 2023 Jul 05. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: SAGE Publications Country of Publication: United States NLM ID: 101274068 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1747-4949 (Electronic) Linking ISSN: 17474930 NLM ISO Abbreviation: Int J Stroke Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2016- : Thousand Oaks, CA : SAGE Publications Original Publication: Oxford, UK : Blackwell Pub., c2005- |
| مواضيع طبية MeSH: | Emergency Medical Services* , Stroke*/drug therapy, Humans ; Fibrinolytic Agents/therapeutic use ; Quality of Life ; Tissue Plasminogen Activator/therapeutic use ; Treatment Outcome ; Clinical Trials as Topic |
| مستخلص: | Background: Few data exist on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. A recent trial of mobile stroke units (MSUs) demonstrated faster treatment and improved outcomes, and included PD patients. Aim: To determine outcomes with tissue plasminogen activator (tPA), and benefit of MSU versus management by emergency medical services (EMS), for PD patients. Methods: Primary outcomes were utility-weighted modified Rankin Scale (uw-mRS). Linear and logistic regression models compared outcomes in patients with versus without PD, and PD patients treated by MSU versus standard management by EMS. Time metrics, safety, quality of life, and health-care utilization were compared. Results: Of the 1047 tPA-eligible ischemic stroke patients, 254 were with PD (baseline mRS 2-5) and 793 were without PD (baseline mRS 0-1). Although PD patients had worse 90-day uw-mRS, higher mortality, more health-care utilization, and worse quality of life than non-disabled patients, 53% returned to at least their baseline mRS, those treated faster had better outcome, and there was no increased bleeding risk. Comparing PD patients treated by MSU versus EMS, 90-day uw-mRS was 0.42 versus 0.36 (p = 0.07) and 57% versus 46% returned to at least their baseline mRS. There was no interaction between disability status and MSU versus EMS group assignment (p = 0.67) for 90-day uw-mRS. Conclusion: PD did not prevent the benefit of faster treatment with tPA in the BEST-MSU study. Our data support inclusion of PD patients in the MSU management paradigm. Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.C. Grotta has received grants from Patient-Centered Outcomes Research Institute (PCORI), NIH, Genentech, CSL Behring, and Chiesi; is a consultant for Frazer, advison the scientific advisory board for Haemonetics and Acticor, and on the DSMB for Prolong Pharma. J.L. Saver receives contracted hourly payments from Bayer, Biogen, Roche, Genentech, Medtronic, Novo Nordisk, and Occlutech for service on clinical trial steering committees and DSMBs. The remaining authors have no disclosures. |
| فهرسة مساهمة: | Keywords: Acute stroke therapy; clinical trial; ischemic stroke; mobile stroke unit; pre-existing disability; tPA |
| المشرفين على المادة: | 0 (Fibrinolytic Agents) EC 3.4.21.68 (Tissue Plasminogen Activator) |
| تواريخ الأحداث: | Date Created: 20230620 Date Completed: 20231201 Latest Revision: 20231201 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1177/17474930231185471 |
| PMID: | 37337357 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1747-4949 |
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| DOI: | 10.1177/17474930231185471 |