Effectiveness of mobile stroke units
in reducing time to thrombolysis in acute
ischemic stroke: a scoping review
Dublin Core
Title
Effectiveness of mobile stroke units
in reducing time to thrombolysis in acute
ischemic stroke: a scoping review
in reducing time to thrombolysis in acute
ischemic stroke: a scoping review
Subject
Mobile stroke unit, Acute ischemic stroke, Thrombolysis, Time to treatment, Prehospital care
Description
Abstract
Background Timely thrombolysis within the golden hour (≤60 min from onset) is critical for minimizing disability in
acute ischemic stroke (AIS). Mobile stroke units (MSUs) enable prehospital thrombolysis, with effectiveness varying
by urban versus rural settings, the presence of an onboard neurologist, and telemedicine models. This study maps
evidence on MSU effectiveness in reducing time to thrombolysis in AIS compared to standard emergency medical
services (EMS), examines factors modulating effectiveness (e.g., geographic setting, operational protocols), and
identifies research gaps.
Methods This scoping review followed the Arksey and O’Malley framework and PRISMA-ScR guidelines. PubMed,
Embase, Google Scholar, Scopus, and Cochrane Library were searched from January 2008 to March 2025 for peer-
reviewed studies reporting thrombolysis timing in AIS with MSUs. Included randomized controlled trials (RCTs),
observational studies, and meta-analyses (using both fixed-effects and random-effects models) were synthesized
narratively, with data on time reductions, treatment rates, outcomes, and limitations extracted by two blinded
reviewers (NA and EK) and tabulated.
Results Thirteen studies (five RCTs, six observational studies, and two meta-analyses) involving 39,800 patients across
urban and mixed settings were included. MSUs reduced the median onset-to-needle time by 20–41 min, increasing
golden-hour rates from less than 5% (EMS) to 21–33%. Urban settings reduced time by 25–41 min and onboard
neurologists by up to 41 min, compared to 20–40 min in rural areas and 30–37 min with telemedicine. Thrombolysis
rates increased by 10–20% with MSUs compared to EMS, with earlier treatment associated with improved 90-day mRS
outcomes of 0–1. Gaps include limited rural data, sparse real-world evidence of cost-effectiveness, and inconsistent
reporting of outcomes.
Conclusion MSUs enhance access to thrombolysis in AIS, resulting in substantial time savings and potential benefits
to outcomes, particularly in urban settings. Further research is needed on rural applicability, cost-effectiveness, and
standardized outcomes to optimize global MSU implementation.
Keywords Mobile stroke unit, Acute ischemic stroke, Thrombolysis, Time to treatment, Prehospital care
Background Timely thrombolysis within the golden hour (≤60 min from onset) is critical for minimizing disability in
acute ischemic stroke (AIS). Mobile stroke units (MSUs) enable prehospital thrombolysis, with effectiveness varying
by urban versus rural settings, the presence of an onboard neurologist, and telemedicine models. This study maps
evidence on MSU effectiveness in reducing time to thrombolysis in AIS compared to standard emergency medical
services (EMS), examines factors modulating effectiveness (e.g., geographic setting, operational protocols), and
identifies research gaps.
Methods This scoping review followed the Arksey and O’Malley framework and PRISMA-ScR guidelines. PubMed,
Embase, Google Scholar, Scopus, and Cochrane Library were searched from January 2008 to March 2025 for peer-
reviewed studies reporting thrombolysis timing in AIS with MSUs. Included randomized controlled trials (RCTs),
observational studies, and meta-analyses (using both fixed-effects and random-effects models) were synthesized
narratively, with data on time reductions, treatment rates, outcomes, and limitations extracted by two blinded
reviewers (NA and EK) and tabulated.
Results Thirteen studies (five RCTs, six observational studies, and two meta-analyses) involving 39,800 patients across
urban and mixed settings were included. MSUs reduced the median onset-to-needle time by 20–41 min, increasing
golden-hour rates from less than 5% (EMS) to 21–33%. Urban settings reduced time by 25–41 min and onboard
neurologists by up to 41 min, compared to 20–40 min in rural areas and 30–37 min with telemedicine. Thrombolysis
rates increased by 10–20% with MSUs compared to EMS, with earlier treatment associated with improved 90-day mRS
outcomes of 0–1. Gaps include limited rural data, sparse real-world evidence of cost-effectiveness, and inconsistent
reporting of outcomes.
Conclusion MSUs enhance access to thrombolysis in AIS, resulting in substantial time savings and potential benefits
to outcomes, particularly in urban settings. Further research is needed on rural applicability, cost-effectiveness, and
standardized outcomes to optimize global MSU implementation.
Keywords Mobile stroke unit, Acute ischemic stroke, Thrombolysis, Time to treatment, Prehospital care
Creator
Nicholas Aderinto1*, Gbolahan Olatunji2
and Emmanuel Kokori2
and Emmanuel Kokori2
Source
https://doi.org/10.1186/s12245-025-00903-6
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Nicholas Aderinto1*, Gbolahan Olatunji2
and Emmanuel Kokori2, “Effectiveness of mobile stroke units
in reducing time to thrombolysis in acute
ischemic stroke: a scoping review,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12809.
in reducing time to thrombolysis in acute
ischemic stroke: a scoping review,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12809.