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@ARTICLE{Rohmann:281789,
      author       = {Rohmann, Jessica L and Piccininni, Marco and Ebinger,
                      Martin and Wendt, Matthias and Weber, Joachim E and
                      Schwabauer, Eugen and Freitag, Erik and Zuber, Martina and
                      Bernhardt, Lydia and Lange, Julia and Erdur, Hebun and
                      Behrens, Janina and Ganeshan, Ramanan and Schlemm, Ludwig
                      and Harmel, Peter and Liman, Thomas G. and Lorenz-Meyer,
                      Irina and Rohrpasser-Napierkowski, Ira and Hille, Annegret
                      and Bohner, Georg and Nabavi, Darius G and Schmehl, Ingo and
                      Ekkernkamp, Axel and Jungehulsing, Gerhard J and Mackert,
                      Bruno-Marcel and Hartmann, Andreas and Endres, Matthias and
                      Audebert, Heinrich J},
      title        = {{E}ffect of {M}obile {S}troke {U}nit {D}ispatch on
                      {P}rocess {P}arameters and {F}unctional {O}utcomes in
                      {P}atients {W}ith {A}cute {S}troke: {T}he ${B}_{PROUD}-2.0$
                      {S}tudy.},
      journal      = {Neurology},
      volume       = {105},
      number       = {9},
      issn         = {0028-3878},
      address      = {Philadelphia, Pa.},
      publisher    = {Wolters Kluwer},
      reportid     = {DZNE-2025-01182},
      pages        = {e214225},
      year         = {2025},
      abstract     = {Prehospital stroke management on mobile stroke units (MSUs)
                      shortens time to IV thrombolysis (IVT) and improves
                      functional outcomes. Because IVT effects are time-dependent,
                      optimizing workflows and dispatch-related processes may
                      enhance MSU benefits. The $B_PROUD-2.0$ study aimed to
                      determine the effect of additional MSU dispatch on
                      functional outcomes in acute stroke patients under optimized
                      MSU organization and service delivery.In the nonrandomized,
                      controlled $B_PROUD-2.0$ study (May 2019-April 2021)
                      conducted in Berlin, Germany, MSUs were simultaneously
                      dispatched with conventional care ambulances for suspected
                      stroke emergency calls, whenever available. We compared
                      outcomes and process parameters between dispatch groups
                      (additional MSU dispatch vs conventional care only) among
                      patients with cerebral ischemia with disabling neurologic
                      symptoms and no contraindications to reperfusion treatments.
                      We used data from the Berlin dispatch center and records
                      from the $B_SPATIAL$ registry, consisting of 15 Berlin
                      hospitals with stroke units. We performed pooled analyses
                      with the $B_PROUD-1.0$ primary population (February
                      2017-April 2021) and with an extended cohort that also
                      included patients with reperfusion treatment
                      contraindications. The primary and co-primary outcomes were
                      3-month modified Rankin Scale scores (0: no deficits to 6:
                      death) and 3-tiered disability scale scores. Effect
                      estimates for these outcomes were obtained from ordinal
                      logistic regressions, adjusting for a priori selected
                      covariates after multiple imputation for missing
                      values.Coronavirus disease 2019 pandemic and limited funding
                      hindered full implementation of procedural improvements. A
                      total of 1,050 patients (mean age: 74 years, $46.7\%$
                      female) were included in $B_PROUD-2.0$ (vs 1,500 planned).
                      We found no statistically significant effect of MSU dispatch
                      on primary (common odds ratio [cOR] 0.90, $95\%$ CI
                      0.72-1.14) or co-primary (cOR 0.86, $95\%$ CI 0.63-1.17)
                      outcomes in $B_PROUD-2.0,$ and higher odds of IVT ≤1 hour
                      of dispatch in the MSU group (OR 10.15, $95\%$ CI
                      7.10-14.51). In pooled $B_PROUD-1.0+2.0$ primary population
                      analyses (N = 2,666, mean age: 73 years, $46.8\%$ female),
                      we found a beneficial effect on primary (cOR 0.80, $95\%$ CI
                      0.67-0.96) and co-primary (cOR 0.79, $95\%$ CI 0.64-0.97)
                      outcomes. The average effect on all stroke/TIA patients in
                      the extended cohort (N = 4,336, mean age 75 years, $47.6\%$
                      female) was also favorable (primary cOR 0.85, $95\%$ CI
                      0.75-0.95; co-primary cOR 0.86, $95\%$ CI 0.75-0.99).While
                      we did not observe statistically significant differences in
                      functional outcomes in the underpowered $B_PROUD-2.0$ study,
                      we found beneficial effects considering both $B_PROUD$ study
                      periods, also when including all stroke/TIA
                      patients.ClinicalTrials.gov: NCT03931616. Registered: April
                      26, 2019. First patient enrolled: May 9, 2019.The
                      $B_PROUD-2.0$ study provides Class III evidence that the
                      addition of MSUs to conventional care ambulances did not
                      improve functional outcomes at 3 months compared with
                      conventional care ambulances alone in patients with acute
                      ischemic stroke.},
      keywords     = {Humans / Female / Male / Aged / Mobile Health Units /
                      Stroke: therapy / Thrombolytic Therapy / Middle Aged / Aged,
                      80 and over / Emergency Medical Services: methods /
                      Ambulances / Time-to-Treatment / Registries / Treatment
                      Outcome / Emergency Medical Dispatch / Berlin / COVID-19},
      cin          = {AG Endres},
      ddc          = {610},
      cid          = {I:(DE-2719)1811005},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41100781},
      doi          = {10.1212/WNL.0000000000214225},
      url          = {https://pub.dzne.de/record/281789},
}