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Pre-hospital stroke treatment linked to fewer disabilities, better survival

While researchers did not see a significant difference among patient groups in the study, they report their data suggests earlier treatment has benefits.

By
Stephen Feller
German researchers found ambulances set up specifically to treat stroke patients improved outcomes, though not significantly in their study of just under 1,000 stroke patients. Doctors generally agree the earlier a stroke patient can start treatment, either with clot-busting drugs or to stop bleeding on the brain, the better outcome they are likely to have. Photo by cleanfotos/Shutterstock
German researchers found ambulances set up specifically to treat stroke patients improved outcomes, though not significantly in their study of just under 1,000 stroke patients. Doctors generally agree the earlier a stroke patient can start treatment, either with clot-busting drugs or to stop bleeding on the brain, the better outcome they are likely to have. Photo by cleanfotos/Shutterstock

BERLIN, Aug. 25 (UPI) -- It's well known that the sooner stroke is treated, the better patients fare and the less likely they are to have a disability after recovery.

Researchers at Charité-University Medicine Berlin found patients who started thrombolysis while in transit to the hospital had fewer severe disabilities and better chance of survival, suggesting mobile stroke units could save a considerable number of lives.

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Roughly 90 percent of strokes are ischemic, or caused by a blood clot in an artery in the brain, while the other 10 percent are hemorraghic, or caused by bleeding on the brain.

When treating a stroke, doctors use computed tomography scanning to confirm the type of stroke a patient has before starting treatment, because thrombolysis -- drugs given to break up blood clots -- would make a hemorraghic stroke worse.

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To test whether earlier treatment of ischemic stroke patients could improve outcomes, the researchers designed a specialized stroke ambulance with a CT scanner, mini-laboratory and ability to deliver thrombolysis.

For the study, published in the journal The Lancet Neurology, the researchers compared 427 patients picked up in a Stroke Emergency Mobile, or STEMO, to 505 brought to a hospital in a traditional ambulance receiving conventional care.

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Patients were assessed 3 months after stroke using the modified Rankin Scale a standard method for measuring disability and dependence in people who have had a stroke. Outcomes were assessed based on the proportion of patients who were living at home without assistance before their stroke and had a three-month modified Rankin Scale score of 1 or lower on a scale of 0 to 6, indicating no significant disability.

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Among the patients, 53 percent of those in the STEMO group and 47 percent of those receiving conventional care had a score of less than 1, a small but statistically insignificant difference in outcome regardless of pre-hospital arrival treatment.

Even without a significant difference, and with larger trials planned for the future, the researchers say the data suggests there is a benefit to faster, earlier treatment, which echoes previous studies on stroke patients.

"The earlier acute stroke treatment starts, the better the outcomes," Dr. Alexander Kunz, a researcher in the Department of Neurology at Charité-University Medicine Berlin, said in a press release. "Data from our study suggest that, wherever possible, treatment should commence prior to arrival at hospital."

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