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Original Research

Open Access

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:

† These authors contributed equally.


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.


Emergency medicine; Neurologic emergencies; Neurology; Gender disparities

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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.


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