Gender Disparities in Stroke Code Activation in Patients with Intracerebral Hemorrhage
| Autor: | Michael E. Reznik, Ali Mahta, Linda C. Wendell, Hari Dandapani, Roshini Kalagara, Shadi Yaghi, Bradford B Thompson, Ethan J. Han, Tracy E. Madsen, Carlin Chuck, Karen L. Furie, Savannah R Doelfel, Christoph Stretz |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Weakness medicine.medical_specialty Stroke care Logistic regression Sex Factors Internal medicine medicine Humans In patient cardiovascular diseases Healthcare Disparities Stroke Cerebral Hemorrhage Retrospective Studies Intracerebral hemorrhage business.industry Rehabilitation Clinical Coding Retrospective cohort study medicine.disease Blood pressure Female Surgery Neurology (clinical) medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Stroke and Cerebrovascular Diseases. 30:106119 |
| ISSN: | 1052-3057 |
| DOI: | 10.1016/j.jstrokecerebrovasdis.2021.106119 |
| Popis: | Objectives Routine implementation of protocol-driven stroke “codes” results in timelier and more effective acute stroke management. However, it is unclear if patient demographics contribute to disparities in stroke code activation. We aimed to explore these demographic factors in a retrospective cohort study of patients with intracerebral hemorrhage (ICH). Materials and Methods We identified consecutive patients with non-traumatic ICH who presented directly to our Comprehensive Stroke Center over 2 years and collected data on demographics, clinical features, and stroke code activation. We used multivariable logistic regression to examine differences in stroke code activation based on patient demographics while adjusting for initial clinical features (NIH Stroke Scale, FAST [facial drooping, arm weakness, speech difficulties] vs. non-FAST symptoms, time from last-known-well [LKW], and systolic blood pressure [SBP]). Results Among 265 patients, 68% (n=179) had a stroke code activation. Stroke codes occurred less frequently in women (62%) than men (72%) and in non-white (57%) vs. white patients (70%). Non-stroke code patients were less likely to have FAST symptoms (37% vs. 87%) and had lower initial SBP (mean±SD 159.3±34.2 vs. 176.0±31.9 mmHg) than stroke code patients. In our primary multivariable models, neither age nor race were associated with stroke code activation. However, women were significantly less likely to have stroke codes than men (OR 0.49 [95% CI 0.24-0.98]), as were non-FAST symptoms (OR 0.11 [95% CI 0.05-0.22]). Conclusions Our data suggest gender disparities in emergency stroke care that should prompt further investigations into potential systemic biases. Increased awareness of atypical stroke symptoms is also warranted. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect