■医院就诊和院前卒中护理的时间差异可能是急性卒中治疗率不平等的重要驱动因素,功能结果,和死亡率。目前还不清楚患者层面的因素,如种族和民族以及县级社会经济地位,影响院前中风护理的这些方面。
■缺血性卒中患者的横断面研究,脑出血,和蛛网膜下腔出血在Get与指南-卒中登记,从2015年7月至2019年12月,症状发作<24小时。多变量逻辑回归和分位数回归用于调查感兴趣的结果:紧急医疗服务(EMS)运输(相对于私人车辆),EMS院前通知(与无院前通知相比),和中风症状发作到到达急诊科的时间。预先指定的协变量包括患者水平,医院级别,县级特色。
■606369例患者符合纳入标准。在患者中,51.2%是男性,69.9%是白人,美国国立卫生研究院卒中严重程度中位数为4(IQR,2-10),和中位数社会剥夺指数(SDI)为51(IQR,27-75).症状发作到到达时间的中位数为176分钟(IQR,64-565)。黑人种族与延长的症状发作至急诊科到达时间显著相关(+28.21分钟[95%CI,25.59-30.84]),和EMS院前通知的几率降低(或,0.80[95%CI,0.78-0.82])。SDI与EMS使用差异不相关,但与EMS院前通知几率较低相关(较高SDI时间与最低,OR,0.79[95%CI,0.78-0.81])。SDI也与卒中症状发作至急诊科到达时间显著相关(较高的SDI时间与最低的+2.56分钟[95%CI,0.58-4.53])。
■在这项全国性的横断面研究中,黑人种族与到达时间间隔的延长和EMS院前通知的几率显着降低有关,尽管类似地使用EMS运输。县级剥夺也与EMS院前通知的几率降低以及中风症状发作到急诊科到达时间的延长有关。减少中风护理中基于地点的差异的努力必须解决急性中风院前护理中的严重不平等,并继续解决与种族和族裔相关的健康不平等。
UNASSIGNED: Disparities in time to hospital presentation and prehospital stroke care may be important drivers in inequities in acute stroke treatment rates, functional outcomes, and mortality. It is unknown how patient-level factors, such as race and ethnicity and county-level socioeconomic status, affect these aspects of prehospital stroke care.
UNASSIGNED: Cross-sectional study of patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage in the Get With the Guidelines-Stroke registry, presenting from July 2015 to December 2019, with symptom onset <24 hours. Multivariable logistic regression and quantile regression were used to investigate the outcomes of interest: emergency medical services (EMS) transport (versus private vehicle), EMS prehospital notification (versus no prehospital notification), and stroke symptom onset to time of arrival at the emergency department. Prespecified covariates included patient-level, hospital-level, and county-level characteristics.
UNASSIGNED: The inclusion criteria was met by the 606 369 patients. Of the patients, 51.2% were men and 69.9% White, with a median National Institutes of Health Stroke Severity of 4 (IQR, 2-10), and median social deprivation index (SDI) of 51 (IQR, 27-75). Median symptom onset to arrival time was 176 minutes (IQR, 64-565). Black race was significantly associated with prolonged symptom onset to emergency department arrival time (+28.21 minutes [95% CI, 25.59-30.84]), and decreased odds of EMS prehospital notification (OR, 0.80 [95% CI, 0.78-0.82]). SDI was not associated with differences in EMS use but was associated with lower odds of EMS prehospital notification (upper SDI tercile versus lowest, OR, 0.79 [95% CI, 0.78-0.81]). SDI was also significantly associated with stroke symptom onset to emergency department arrival time (upper SDI tercile versus lowest +2.56 minutes [95% CI, 0.58-4.53]).
UNASSIGNED: In this national cross-sectional study, Black race was associated with prolonged onset to time of arrival intervals and significantly decreased odds of EMS prehospital notification, despite similar use of EMS transport. Greater county-level deprivation was also associated with reduced odds of EMS prehospital notification and slightly prolonged stroke symptom onset to emergency department arrival time. Efforts to reduce place-based disparities in stroke care must address significant inequities in prehospital care of acute stroke and continue to address health inequities associated with race and ethnicity.