Treatment first, transport second: rethinking stroke management with mobile stroke units—A systematic review and meta-analysis of controlled trials

Background Stroke is a significant cause of morbidity and mortality, with profound medical and economic consequences. Accurate diagnosis and minimizing delays in acute stroke management has become a global priority. Mobile stroke units (MSUs) have the potential to effectively shorten key time intervals. Objective We conducted this review aiming to investigate the benefits of MSU implementation on functional, safety and time metrics outcomes in acute stroke care. Moreover, we assessed whether the presence of an onboard neurologist is essential for MSU implementation. Results The analysis consisted of 10 studies involving 13,110 patients (4,350 MSU; 8,760 EMS). The pooled median difference favors MSU intervention over the control by 26.3 min [95% CI (20.1–32.4), p 2 =0.12, df = 1, p = 0.7241). Both safety outcomes showed non-significant pooled odds ratios, ICH 1.019 [95% CI (0.71,1.45), p = 0.918] and mortality 1.23 [95% CI (0.85, 1.77), p = 0.271]. Conclusions In this review, it was demonstrated that MSUs have markedly improved some of the critical time metrics of acute stroke care through clinically meaningful reductions of ~10–35 min, while maintaining safety outcomes comparable to traditional EMS care. We found no significant differences considering the impact of onboard and remote neurologist models in MSUs, highlighting that remote neurologists in MSUs could potentially be a more cost-effective model. Systematic review registration PROSPERO; registration number: CRD420261297860.