Corresponding Author: Heinrich J. Audebert, MD, Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany (heinrich.audebert@charite.de).
Correction: This article was corrected on April 6, 2021, to add the group name and make other minor edits.
Accepted for Publication: December 18, 2020.
Author Contributions: Dr Audebert had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Ebinger, Siegerink, Behrens, Nolte, Wiener, Nabavi, Endres, Audebert.
Acquisition, analysis, or interpretation of data: Ebinger, Siegerink, Kunz, Wendt, Weber, Schwabauer, Geisler, Freitag, Lange, Erdur, Ganeshan, Liman, Scheitz, Schlemm, Harmel, Zieschang, Lorenz-Meyer, Napierkowski, Waldschmidt, Nolte, Grittner, Wiener, Bohner, Schmehl, Ekkernkamp, Jungehulsing, Mackert, Hartmann, Rohmann, Audebert.
Drafting of the manuscript: Ebinger, Grittner, Wiener, Rohmann.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Siegerink, Napierkowski, Grittner, Rohmann, Audebert.
Obtained funding: Ebinger, Harmel, Endres, Audebert.
Administrative, technical, or material support: Kunz, Wendt, Weber, Schwabauer, Geisler, Freitag, Behrens, Ganeshan, Liman, Harmel, Lorenz-Meyer, Napierkowski, Waldschmidt, Nolte, Nabavi, Ekkernkamp, Jungehulsing, Mackert, Audebert.
Supervision: Ebinger, Siegerink, Wendt, Freitag, Nolte, Wiener, Nabavi, Schmehl, Ekkernkamp, Jungehulsing, Endres, Audebert.
Other - epidemiological expertise, tables and figures: Rohmann.
Other: Hartmann.
Conflict of Interest Disclosures: Drs Ebinger, Siegerink, Kunz, Weber, Geisler, Freitag, Erdur, Ganeshan, Schlemm, Harmel, Lorenz-Meyer, Napierkowski, Waldschmidt, Endres, and Audebert reported receiving institutional grants from the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG) and the Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF) during the conduct of the study. Dr Geisler reported receiving other support from Johnson and Johnson and AbbVie. Dr Scheitz reported receiving personal fees from Bristol Myers Squibb and Stryker GmbH & Co KG. Dr Schlemm reported receiving personal fees from Daiichi Sankyo. Dr Nolte reported receiving personal fees from Boehringer Ingelheim, Bristol Myers Squibb, Pfizer Pharma, and Abbott and research grants from the German Ministry of Research and Education, the German Center for Neurodegenerative Diseases, and the German Center for Cardiovascular Research. Dr Grittner reported receiving personal fees from Centogene AG, Rostock, Germany. Ms Rohmann reported receiving a grant from Novartis Pharma for conducting a self-initiated research project on migraine remission in aging. Dr Endres reported receiving grantEXC-2049–390688087 from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany's Excellence Strategy (NeuroCure) Charité–Universitätsmedizin Berlin and from Bundesministerium für Bildung und Forschung (BMBF; German Ministry for Education and Research) for the Center for Stroke Research Berlin and grants from Bayer and other support from Bayer Boehringer Ingelheim, BMS, Pfizer, Daiichi Sankyo, Amgen, GSK, Sanofi, Covidien, Novartis. Dr Audebert reported receiving personal fees from Bayer Vital, Boehringer Ingelheim, Bristol Myers Squibb, Novo Nordisk, Pfizer, and Sanofi. No other disclosures were reported.
Funding/Support: The B_PROUD study was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation), the B-SPATIAL registry, by the Federal Ministry of Education and Research via the Center for Stroke Research Berlin. Additional analyses requested during the review process and performed by the Institut für Biometrie und klinische Epidemiologie, Charité—Universitätsmedizin Berlin was funded by the Verein zur Förderung der Hirnforschung und Rehabilitation e.V.
Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank the Berlin Fire Brigade, responsible for the Berlin Dispatch Center and EMS, for continuous collaboration and support. We thank Farid I. Kandil, Dr rer nat, Dipl Psych, Charité–Universitätsmedizin Berlin, for support with the forest plots; the Berlin Data Protection Office (Berliner Beauftragte für Datenschutz und Informationsfreiheit) for advice; Janet Fahron, data protection officer of the Charité–Universitätsmedizin Berlin, for her continuous support in advising and consulting; the Berlin Technology Foundation and Berlin Partner for funding of previous stages of the Berlin STEMO project, none of whom received compensation for their role in the study. Finally, we thank all collaborating hospitals and the study nurses for their support.
Additional Information: The investigators at the trial sites listed in the Supplement 3 were responsible for collecting the data.
External Statistical Reviewer: André Karch, MSc, Clinical Epidemiology, University of Muenster, Muenster, Germany.
1.Powers
WJ , Rabinstein
AA , Ackerson
T ,
et al. Guidelines for the early management of patients with acute ischemic Stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.
Stroke. 2019;50(12):e344-e418. doi:
10.1161/STR.0000000000000211
PubMedGoogle ScholarCrossref 6.Ebinger
M , Winter
B , Wendt
M ,
et al; STEMO Consortium. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial.
JAMA. 2014;311(16):1622-1631. doi:
10.1001/jama.2014.2850
PubMedGoogle ScholarCrossref 8.Wendt
M , Ebinger
M , Kunz
A ,
et al; STEMO Consortium. Improved prehospital triage of patients with stroke in a specialized stroke ambulance: results of the pre-hospital acute neurological therapy and optimization of medical care in stroke study.
Stroke. 2015;46(3):740-745. doi:
10.1161/STROKEAHA.114.008159PubMedGoogle ScholarCrossref 9.Kunz
A , Ebinger
M , Geisler
F ,
et al. Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study.
Lancet Neurol. 2016;15(10):1035-1043. doi:
10.1016/S1474-4422(16)30129-6
PubMedGoogle ScholarCrossref 11.Kobayashi
A , Czlonkowska
A , Ford
GA ,
et al. European Academy of Neurology and European Stroke Organization consensus statement and practical guidance for pre-hospital management of stroke.
Eur J Neurol. 2018;25(3):425-433. doi:
10.1111/ene.13539
PubMedGoogle ScholarCrossref 23.Helwig
SA , Ragoschke-Schumm
A , Schwindling
L ,
et al. Prehospital stroke management optimized by use of clinical scoring vs mobile stroke unit for triage of patients with stroke: a randomized clinical trial.
JAMA Neurol. 2019. doi:
10.1001/jamaneurol.2019.2829
PubMedGoogle Scholar 28.Dietrich
M , Walter
S , Ragoschke-Schumm
A ,
et al. Is prehospital treatment of acute stroke too expensive? an economic evaluation based on the first trial.
Cerebrovasc Dis. 2014;38(6):457-463. doi:
10.1159/000371427
PubMedGoogle ScholarCrossref