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Original Research

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Gender differences in time from arrival to stroke team activation in patients presenting with acute stroke symptoms

  • Kevin A Kotkowski1
  • Evangelia Murray1,2,†
  • Martin A Reznek1,†
  • Sean S Michael1,2,†

1University of Massachusetts Medical School, Department of Emergency Medicine, 55 Lake Ave N, Worcester, MA 01655, USA

2University of Colorado School of Medicine, Department of Emergency Medicine, 12401 E 17th Ave #B-215, Aurora, CO 80016, USA

DOI: 10.22514/sv.2021.051 Vol.17,Issue 3,May 2021 pp.130-136

Submitted: 01 January 2021 Accepted: 20 February 2021

Published: 08 May 2021

*Corresponding Author(s): Kevin A Kotkowski E-mail: Kevin.kotkowski@umassmemorial.org

† These authors contributed equally.

Abstract

Background and Purpose: Women are more likely to experience delays in evaluation and treatment for acute stroke. As national guidelines increasingly emphasize the importance of rapid stroke intervention, it is important to further investigate this gender disparity. We sought to evaluate whether door-to-stroke activation time varied by patient gender among patients for whom stroke team activation occurred in the emergency department (ED).

Methods: This was a retrospective analysis of a prospectively collected registry of all patients for whom the stroke team was activated in the ED of an urban, academic, regional stroke center over 1 year. Our primary outcome was door to stroke activation time (DTA), with the primary predictor of interest being patient gender. We assessed for differences in DTA using multivariable Cox proportional hazards and logistic regression models.

Results: There were 211 patient encounters included in the study, 117 women and 94 males. Median DTA was 8 minutes longer for women, and women were less likely to have DTA ≤ 15 minutes (odds ratio 0.26 [95% confidence interval 0.12 to 0.58]).

Conclusion: A gender disparity existed in door to activation time for women presenting with suspected acute stroke, even when controlling for a variety of factors. These results provide evidence that gender may impact initial management of stroke patients.


Keywords

Emergency medicine; Neurologic emergencies; Neurology; Gender disparities


Cite and Share

Kevin A Kotkowski,Evangelia Murray,Martin A Reznek,Sean S Michael. Gender differences in time from arrival to stroke team activation in patients presenting with acute stroke symptoms. Signa Vitae. 2021. 17(3);130-136.

References

[1] Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke. Stroke. 2013; 44: 870-947.

[2] Marler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Grotta JC, et al. Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology. 2000; 55: 1649-1655.

[3] Morgenstern LB, Kissela BM. Stroke Disparities. Stroke. 2015; 46: 3560-3563.

[4] Centers for Disease Control and Prevention. Prehospital and hospital delays after stroke onset-United States, 2005-2006. Morbidity and Mortality Weekly Report. 2007; 56: 474-478.

[5] Kelly AG, Hellkamp AS, Olson D, Smith EE, Schwamm LH. Predictors of rapid brain imaging in acute stroke. Stroke. 2012; 43: 1279-1284.

[6] Reznek MA, Murray E, Youngren MN, Durham NT, Michael SS. Door-to-imaging time for acute stroke patients is adversely affected by emergency department crowding. Stroke. 2017; 48: 49-54.

[7] Jungehulsing GJ, Rossnagel K, Nolte CH, Muller-Nordhorn J, Roll S, Klein M, et al. Emergency department delays in acute stroke-analysis of time between ED arrival and imaging. European Journal of Neurology. 2006; 13: 225-232.

[8] Rose KM, Rosamond WD, Huston SL, Murphy CV, Tegeler CH. Predictors of time from hospital arrival to initial brain-imaging among suspected stroke patients: the North Carolina Collaborative Stroke Registry. Stroke. 2008; 39: 3262-3267.

[9] Smith MA, Lisabeth LD, Brown DL, Morgenstern LB. Gender compar-isons of diagnostic evaluation for ischemic stroke patients. Neurology. 2005; 65: 855-858.

[10] de Ridder I, Dirks M, Niessen L, Dippel D. Unequal access to treatment with intravenous alteplase for women with acute ischemic stroke. Stroke. 2013; 44: 2610-2612.

[11] Knauft W, Chhabra J, McCullough LD. Emergency department arrival times, treatment, and functional recovery in women with acute ischemic stroke. Journal of Women’s Health. 2010; 19: 681-688.

[12] Reeves MJ, Bushnell CD, Howard G, Gargano JW, Duncan PW, Lynch G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. The Lancet Neurology. 2008; 7: 915-926.

[13] Reeves MJ, Wilkins T, Lisabeth LD, Schwamm LH. Thrombolysis treatment for acute stroke: issues of efficacy and utilization in women. Women’s Health. 2011; 7: 383-390.

[14] McDermott M, Lisabeth LD, Baek J, Adelman EE, Garcia NM, Case E, et al. Sex disparity in stroke quality of care in a community-based study. Journal of Stroke and Cerebrovascular Diseases. 2017; 26: 1781-1786.

[15] Reeves M, Bhatt A, Jajou P, Brown M, Lisabeth L. Sex differences in the use of intravenous rt-PA thrombolysis treatment for acute ischemic stroke: a meta-analysis. Stroke. 2009; 40: 1743-1749.

[16] Arnao V, Caso V. Sex-related differences of acute stroke unit care: results from the Austrian stroke unit registry. Women’S Health. 2014; 10: 487-489.

[17] Bushnell CD, Hurn P, Colton C, Miller VM, del Zoppo G, Elkind MSV, et al. Advancing the study of stroke in women: summary and recommendations for future research from an NINDS-Sponsored Multidisciplinary Working Group. Stroke. 2006; 37: 2387-2399.

[18] Gargano JW, Wehner S, Reeves MJ. Do presenting symptoms explain sex differences in emergency Department Delays among Patients with Acute Stroke? Stroke. 2009; 40: 1114-1120.

[19] Jungehulsing GJ, Rossnagel K, Nolte CH, Muller-Nordhorn J, Roll S, Klein M, et al. Emergency department delays in acute stroke - analysis of time between ED arrival and imaging. European Journal of Neurology. 2006; 13: 225-232.

[20] Madsen TE, Seigel TA, Mackenzie RS, Marcolini EG, Wira CR, Healy ME, et al. Gender differences in neurologic emergencies part I: a consensus summary and research agenda on cerebrovascular disease. Academic Emergency Medicine. 2014; 21: 1403-1413.

[21] Tafreshi GM, Raman R, Ernstrom K, Meyer BC, Hemmen TM. Gender differences in acute stroke treatment: the University of California San Diego experience. Stroke. 2010; 41: 1755-1757.

[22] Madsen TE, Choo EK, Seigel TA, Palms D, Silver B. Lack of gender disparities in emergency department triage of acute stroke patients. The Western Journal of Emergency Medicine. 2015; 16: 203-209.

[23] Fonarow GC, Smith EE, Saver JL, Reeves MJ, Hernandez AF, Peterson ED, et al. Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association’s Target: Stroke initiative. Stroke. 2011; 42: 2983-2989.

[24] Ruff IM, Ali SF, Goldstein JN, Lev M, Copen WA, McIntyre J, et al. Improving door-to-needle times. Stroke. 2014; 45: 504-508.

[25] Mistry B, Stewart De Ramirez S, Kelen G, Schmitz PSK, Balhara KS, Levin S, et al. Accuracy and reliability of emergency department triage using the emergency severity index: an international multicenter assessment. Annals of Emergency Medicine. 2017; 71: 581-587.e3.

[26] Xian Y, Xu H, Lytle B, Blevins J, Peterson ED, Hernandez AF, et al. Use of strategies to improve door-to-needle times with tissue-type plasminogen activator in acute ischemic stroke in clinical practice: findings from target: stroke. Circulation. Cardiovascular Quality and Outcomes. 2017; 10: e003227.

[27] McCarthy ML, Aronsky D, Jones ID, Miner JR, Band RA, Baren JM, et al. The emergency department occupancy rate: a simple measure of emergency department crowding? Annals of Emergency Medicine. 2008; 51: 15-12.

[28] Harrell FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Statistics in Medicine. 1996; 15: 361-387.

[29] Labiche LA, Chan W, Saldin KR, Morgenstern LB. Sex and acute stroke presentation. Annals of Emergency Medicine. 2002; 40: 453-460.

[30] Lisabeth LD, Brown DL, Hughes R, Majersik JJ, Morgenstern LB. Acute stroke symptoms. Stroke. 2009; 40: 2031-2036.

[31] Arboix A, Cartanyà A, Lowak M, García-Eroles L, Parra O, Oliveres M, et al. Gender differences and woman-specific trends in acute stroke: Results from a hospital-based registry (1986-2009). Clinical Neurology and Neurosurgery. 2014; 127: 19-24.


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