Stroke alert: Examining demographic disparities in prehospital stroke care

Demographic disparities are present throughout the continuum of stroke care. However, information about prehospital disparities in stroke care is limited, potentially due to incomplete race and ethnicity recording. This study aims to evaluate disparities across a spectrum of stroke metrics in the prehospital environment to inform opportunities for improvement in care.

This is a retrospective data review of adult Milwaukee County EMS patients with a stroke alert activation from February 2020 to September 2022. Predictors included patient race/ethnicity, gender, and age. Outcomes were based on national stroke quality measures and included documentation metrics, care metrics, and time metrics.

Among 2671 patients with stroke activation alerts, Black patients were less likely to have a stroke scale recorded or have a scene time less than 15 min, and more likely to have glucose acquired and be transported emergently than White patients. They also had longer times to stroke alert and total scene times. Hispanic/Latino patients were also more likely to be transported emergently, as were male patients. Older patients were more likely to have a stroke scale recorded, and younger patients were less likely to have an early alert.

We identified demographic differences at multiple points in the prehospital stroke care continuum. These disparities may contribute to worse stroke outcomes for certain groups of patients and provide opportunity for intervention and quality improvement.