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Gender Disparities in Stroke Code Activation in Patients with Intracerebral Hemorrhage
Savannah R Doelfel1, Roshini Kalagara2, Ethan J Han1
1Department of Neurology, Brown University, Alpert Medical School, Providence, RI, United States.
Insights
Stroke code activation is less frequent in women compared to men, indicating potential gender disparities in emergency stroke care. Further research is needed to address these differences and improve acute stroke management for all patients.
Area of Science:
- Neurology
- Emergency Medicine
- Health Disparities
Background:
- Protocol-driven stroke codes improve acute stroke management.
- Demographic factors potentially influence stroke code activation and acute stroke care.
- Intracerebral hemorrhage (ICH) management requires timely and effective interventions.
Purpose of the Study:
- To investigate demographic factors, specifically gender and race, associated with stroke code activation in patients with intracerebral hemorrhage (ICH).
- To identify potential disparities in emergency stroke care based on patient demographics.
Main Methods:
- Retrospective cohort study of 265 patients with non-traumatic ICH.
- Data collected on demographics, clinical features, and stroke code activation.
- Multivariable logistic regression analysis adjusted for NIH Stroke Scale, FAST symptoms, LKW, and SBP.
Main Results:
- 68% of patients (n=179) had stroke code activation.
- Women (62%) and non-white patients (57%) had lower stroke code activation rates than men (72%) and white patients (70%).
- Women were significantly less likely to receive stroke codes (OR 0.49). Non-FAST symptoms also predicted lower activation (OR 0.11).
Conclusions:
- Gender disparities exist in emergency stroke care, particularly for intracerebral hemorrhage.
- Further investigation into systemic biases within stroke care protocols is warranted.
- Increased clinician awareness of atypical stroke symptoms is crucial for equitable care.
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.
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