Abstract WP190: From Ambulance to ICU: Direct Admission to the Neuro ICU from the Mobile Stroke Treatment Unit

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Introduction: Mobile Stroke Treatment Units (MSTUs) are redefining the framework of acute stroke care by bringing the hospital to the patient and reducing time to treatment. Patients treated with tenecteplase (TNK) in the MSTU may bypass the Emergency Department (ED) and be admitted directly to the Neuro ICU. Previous research has demonstrated the benefit of quicker treatment onboard an MSTU for stroke patients, but no studies have been published about the benefits of direct admission to an ICU from an MSTU. Therefore, we aim to evaluate the ‘direct to’ process for improved patient care and outcomes as compared to patients being taken to the hospital by the standard emergency medical services (EMS) to ED pathway. Methods: We conducted a retrospective study of stroke patients at a large academic hospital between July 2023 and July 2025. We included patients with a final diagnosis of ischemic stroke who received IV TNK. Non-ischemic diagnoses (e.g., intracerebral hemorrhage and stroke mimics) were excluded. Patients were categorized into MSTU Direct-to-Neuro ICU or the standard EMS-to-ED groups. We evaluated total hospital length of stay (LOS) and functional outcomes measured by modified Rankin Score (mRS) at discharge. An mRS of 0-2 was defined as a good outcome. Chi-square test was used for categorical variables and Mann-Whitney U test for continuous variables. Results: Our cohort consisted of 87 patients; 22 (25.3%) arrived by MSTU and 65 (74.7%) arrived by EMS. Median age was 79 [IQR: 63-86] in MSTU and 70 [IQR: 59-78] in EMS (p=0.078) groups. Patients were 66.7% female in the MSTU and 47.7% in the EMS groups (p=0.207), and race distributions were similar (p=0.168). Total hospital LOS was shorter for patients directly admitted through the MSTU when compared to those from the ED (3.41 [IQR: 1.89-4.44] vs 5.62 [IQR: 3.18-8.74] days, p=0.032). There was no statistically significant difference in good functional outcomes at discharge between groups (MSTU 52.4% vs EMS 55.9%, p=0.980). Conclusion: Our results show that the Direct-to-Neuro ICU approach for MSTU patients was associated with shorter hospital LOS, suggesting potential for optimizing resource use. This approach also appeared safe in our cohort, with similar functional outcomes at discharge. Larger studies are needed to validate our results.

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