I basically want to say the same thing as u/lostlogin said about CT for determination of what stroke it is, but maybe add some details.
You're basically looking at ischemic vs hemorrhagic stroke. Ischemic stroke can get tPA or thrombectomy (within a 4.5hr window based on current data). We're a bit more limited with hemorrhagic stroke, but some surgeries are successful (clipping, coil embolization, etc).
From most studies, the sensitivity of noncontrast head CT ruling out a hemorrhagic stroke (most likely due to an aneurysmal hemorrhage) is around 98-99%.[1] These tests are fast, take maybe 2-3 minutes, and the entire hospital will move heaven and earth for a stroke alert.
Why is this important? Because you're essentially limited by transport to the hospital. The MRI in ambulance will save you maybe 20-30 minutes at most. It may help some, sure, but I don't think it would be as massive a benefit as you would expect.
You could argue that we should be administering tPA en route to hospital, and that can certainly be debated. I would say that the risks of tPA administration are pretty high, and should be done while in a hospital to manage any adverse effects such as hemorrhage. Maybe if we develop better safer clot busting tools we could improve morbidity after stroke.
My vote would be to increase preventative care, so that people stop having as many strokes. It would likely be more cost effective in the long run, but I'm no economist.
P.S. your fun fact for the day is that hospitals generally lose money from strokes and tPA administration. The real money is in procedures like thrombectomy! And maybe live close to a stroke center if you're at high risk (diabetes, hypertension, coaguable)
To follow up a bit more, there isn’t really any data on the time required for a mobile MRI, but we already have ambulances fitted out with ct for stroke detection operating in many cities
Off the top of my head:
Increase access to primary care
Encourage behavioral change in people that help prevent disease (stop smoking, or don't eat sugary foods, etc)
Increase treatment affordability for preventing disease
Add on cheap treatment options if patients fail the above (more aspirin, statin, metformin, etc)
You're basically looking at ischemic vs hemorrhagic stroke. Ischemic stroke can get tPA or thrombectomy (within a 4.5hr window based on current data). We're a bit more limited with hemorrhagic stroke, but some surgeries are successful (clipping, coil embolization, etc).
From most studies, the sensitivity of noncontrast head CT ruling out a hemorrhagic stroke (most likely due to an aneurysmal hemorrhage) is around 98-99%.[1] These tests are fast, take maybe 2-3 minutes, and the entire hospital will move heaven and earth for a stroke alert.
Why is this important? Because you're essentially limited by transport to the hospital. The MRI in ambulance will save you maybe 20-30 minutes at most. It may help some, sure, but I don't think it would be as massive a benefit as you would expect.
You could argue that we should be administering tPA en route to hospital, and that can certainly be debated. I would say that the risks of tPA administration are pretty high, and should be done while in a hospital to manage any adverse effects such as hemorrhage. Maybe if we develop better safer clot busting tools we could improve morbidity after stroke.
My vote would be to increase preventative care, so that people stop having as many strokes. It would likely be more cost effective in the long run, but I'm no economist.
P.S. your fun fact for the day is that hospitals generally lose money from strokes and tPA administration. The real money is in procedures like thrombectomy! And maybe live close to a stroke center if you're at high risk (diabetes, hypertension, coaguable)
[1] https://www.ahajournals.org/doi/10.1161/STROKEAHA.115.011386