THREE-MONTH FUNCTIONAL OUTCOMES FOLLOWING MOBILE STROKE UNIT CARE VERSUS CONVENTIONAL STROKE CARE: A BAYESIAN MULTINOMIAL META-ANALYSIS...
Author(s)
Junaid KP, Ph.D.1, Archana Thakur, MD1, Devang R. Raval, Sr., MPH1, Dhaval Parmar, Sr., PhD1, Somen Saha, Ph.D.1, Krushnachandra Sahoo, Ph.D.2, Deepak B. Saxena, PhD1, Kavitha Rajsekar, Ph.D.2, Vikas Dhikav, Ph.D.2.
1Indian Institute of Public Health Gandhinagar, Gandhinagar, India, 2Indian Council of Medical Research, New Delhi, India.
1Indian Institute of Public Health Gandhinagar, Gandhinagar, India, 2Indian Council of Medical Research, New Delhi, India.
OBJECTIVES: This systematic review and meta-analysis aimed to compare 3-month functional outcomes, expressed as modified Rankin Scale (mRS 0-6) distributions, between MSU and conventional stroke care. Secondary objectives were to compare thrombolysis and thrombectomy rates between the two pathways.
METHODS: MEDLINE, Embase, Web of Science, and Scopus were searched for studies published between 2000 and 2025. Randomized controlled trials, non-randomized controlled trials, cohort studies, comparative observational studies, and registry analyses comparing MSU with conventional stroke care among acute ischemic stroke (AIS) or intracranial hemorrhage (ICH) patients were eligible. Pooled 3-month mRS distributions were estimated using Bayesian random-effects multinomial logistic regression. Thrombolysis and thrombectomy outcomes were synthesized using random-effects meta-analysis.
RESULTS: A total of 11,203 records were identified, and 28 studies were included in the clinical effectiveness synthesis. Among AIS patients, pooled 3-month mRS probabilities from six studies showed a higher probability of excellent outcome with MSU compared with standard care: mRS-0: 0.269 versus 0.216 and mRS-1: 0.213 versus 0.190. Probabilities of severe disability or death were lower with MSU: mRS-5: 0.041 versus 0.061 and mRS-6: 0.108 versus 0.135 units. Among ICH patients, based on two studies, estimated mRS distributions were broadly comparable, although uncertainty was substantial. MSU care was associated with significantly higher thrombolysis rates than standard care, with a pooled risk ratio of 1.47 (95% CI: 1.11-1.95; p = 0.007). Thrombectomy rates were not significantly different between groups (RR: 1.16; 95% CI: 0.93-1.46; p = 0.193).
CONCLUSIONS: MSUs improve 3-month functional outcomes in AIS, primarily by increasing timely thrombolysis. Evidence for ICH remains limited. Bayesian multinomial modelling provides clinically meaningful mRS state probabilities to inform cost-effectiveness models and health technology assessment of MSU implementation.
METHODS: MEDLINE, Embase, Web of Science, and Scopus were searched for studies published between 2000 and 2025. Randomized controlled trials, non-randomized controlled trials, cohort studies, comparative observational studies, and registry analyses comparing MSU with conventional stroke care among acute ischemic stroke (AIS) or intracranial hemorrhage (ICH) patients were eligible. Pooled 3-month mRS distributions were estimated using Bayesian random-effects multinomial logistic regression. Thrombolysis and thrombectomy outcomes were synthesized using random-effects meta-analysis.
RESULTS: A total of 11,203 records were identified, and 28 studies were included in the clinical effectiveness synthesis. Among AIS patients, pooled 3-month mRS probabilities from six studies showed a higher probability of excellent outcome with MSU compared with standard care: mRS-0: 0.269 versus 0.216 and mRS-1: 0.213 versus 0.190. Probabilities of severe disability or death were lower with MSU: mRS-5: 0.041 versus 0.061 and mRS-6: 0.108 versus 0.135 units. Among ICH patients, based on two studies, estimated mRS distributions were broadly comparable, although uncertainty was substantial. MSU care was associated with significantly higher thrombolysis rates than standard care, with a pooled risk ratio of 1.47 (95% CI: 1.11-1.95; p = 0.007). Thrombectomy rates were not significantly different between groups (RR: 1.16; 95% CI: 0.93-1.46; p = 0.193).
CONCLUSIONS: MSUs improve 3-month functional outcomes in AIS, primarily by increasing timely thrombolysis. Evidence for ICH remains limited. Bayesian multinomial modelling provides clinically meaningful mRS state probabilities to inform cost-effectiveness models and health technology assessment of MSU implementation.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
CO13
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment, Comparative Effectiveness or Efficacy
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)