Background
Some studies of stroke patients report longer prehospital delays in women, but others
conflict; studies vary in their inclusion of factors including age and stroke severity.
We aimed to investigate the relationship between gender and time to emergency department
(ED) arrival and the influence of age and stroke severity on this relationship.
Methods
Ischemic stroke patients 20 years old or older who presented to 15 hospitals within
a 5-county region of Greater Cincinnati/Northern Kentucky during 2010 were included.
Time from symptom onset to ED arrival and covariates were abstracted by study nurses
and reviewed by study physicians. Data were analyzed using logistic regression with
time to arrival dichotomized at 3 hours or less in the overall sample and then stratified
by National Institutes of Health Stroke Scale (NIHSS) and age.
Results
1991 strokes (55% women) were included. Time to arrival was slightly longer in women
(geometric mean 337 minutes [95% confidence interval {CI} 307-369] versus 297 [95%
CI 268-329], P = .05), and 24% of women versus 27% of men arrived within 3 hours (P = .15). After adjusting for age, race, NIHSS, living situation, and other covariates,
gender was not associated with delayed time to arrival (OR = 1.00, 95% CI .78-1.28).
This did not change across age or NIHSS categories.
Conclusions
After adjusting for factors including age, NIHSS score, and living alone, women and
men with ischemic stroke had similar times to arrival. Arrival time is not likely
a major contributor to differences in outcome between men and women.
Key Words
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References
- Sex disparity in the access of elderly patients to acute stroke care.Stroke. 2007; 38: 2123-2126
- Perceptual, social, and behavioral factors associated with delays in seeking medical care in patients with symptoms of acute stroke.Stroke. 2006; 37: 1248-1253
- Gender differences in emergency stroke care and hospital outcome in acute ischemic stroke: a multicenter observational study.Am J Emerg Med. 2013; 31: 178-184
- The role of ethnicity, sex, and language on delay to hospital arrival for acute ischemic stroke.Stroke. 2010; 41: 905-909
- Unequal access to treatment with intravenous alteplase for women with acute ischemic stroke.Stroke. 2013; 44: 2610-2612
- Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry.Stroke. 2003; 34: 1114-1119
- Analysis of tissue plasminogen activator eligibility by sex in the Greater Cincinnati/Northern Kentucky Stroke Study.Stroke. 2015; 46: 717-721
- Out-of-hospital delays in patients with acute stroke.Ann Emerg Med. 2004; 44: 476-483
- Clinical characteristics of patients with early hospital arrival after stroke symptom onset.J Stroke Cerebrovasc Dis. 2005; 14: 272-277
- Does sex influence the response to intravenous thrombolysis in ischemic stroke? Answers from safe implementation of treatments in Stroke-International Stroke Thrombolysis Register.Stroke. 2013; 44: 3401-3406
- Sex-related differences of acute stroke unit care: results from the Austrian stroke unit registry.Stroke. 2014; 45: 1632-1638
- Sex differences in long-term outcomes after stroke: functional outcomes, handicap, and quality of life.Stroke. 2012; 43: 1982-1987
- Factors influencing sex differences in poststroke functional outcome.Stroke. 2015; 46: 860-863
- Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 1545-1588
- Sex differences in the use of intravenous rt-PA thrombolysis treatment for acute ischemic stroke: a meta-analysis.Stroke. 2009; 40: 1743-1749
- The Greater Cincinnati/Northern Kentucky Stroke Study: preliminary first-ever and total incidence rates of stroke among blacks.Stroke. 1998; 29: 415-421
- Retrospective assessment of initial stroke severity with the NIH Stroke Scale.Stroke. 2000; 31: 858-862
- Sex and acute stroke presentation.Ann Emerg Med. 2002; 40: 453-460
- Distribution of National Institutes of Health Stroke Scale in the Cincinnati/Northern Kentucky Stroke Study.Stroke. 2013; 44: 3211-3213
- Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis: a retrospective analysis of the Get With the Guidelines-Stroke registry.JAMA Neurol. 2015; 72: 423-431
- Outcomes in mild or rapidly improving stroke not treated with intravenous recombinant tissue-type plasminogen activator: findings from Get With The Guidelines-Stroke.Stroke. 2011; 42: 3110-3115
- Emergency medical services use by stroke patients: a population-based study.Am J Emerg Med. 2009; 27: 141-145
- Which stroke symptoms prompt a 911 call? A population-based study.Am J Emerg Med. 2010; 28: 607-612
Article info
Publication history
Published online: November 23, 2015
Accepted:
October 27,
2015
Received in revised form:
October 9,
2015
Received:
September 4,
2015
Footnotes
Source of funding: This study was funded by a grant from the National Institute of Neurological Disorders and Stroke (Grant no. RO1 NS 30678).
Conflicts of interest: Dawn Kleindorfer is a consultant for Genentech. Dr. Felipe De Los Rios La Rosa is a member of Boehringer Ingelheim speaker's bureau. Dr. Pooja Khatri's Department of Neurology at University of Cincinnati received financial support for her research-related activities from Genentech (PRISMS Trial Lead PI), Penumbra (THERAPY Trial Neurology PI), and Biogen (DSMB member). Dr. Matthew Flaherty is on the speaker's bureau for CSL Behring and Janssen, the principal investigator of a phase II National Institute of Neurological Disorders and Stroke-funded treatment trial of intracerebral hemorrhage and study drug supplied by Novo Nordisk, and receives research support from a Bristol-Myers Squibb/Pfizer Medical Educational Grant.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.026
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
