Pre-stroke emergency department utilization in the Brain Attack Surveillance in Corpus Christi (BASIC) project

Area of Science:

• Neurology
• Public Health
• Epidemiology

Background:

• Pre-stroke emergency department (ED) visits may offer crucial opportunities for stroke prevention strategies.
• Evaluating the prevalence and predictors of ED visits in the 90 days preceding a stroke is essential.
• Identifying visits for high-risk diagnoses associated with short-term stroke risk (e.g., neurologic symptoms, atrial fibrillation, falls, hypertensive disorders) is key.

Purpose of the Study:

• To determine the prevalence and predictors of ED visits within 90 days before a stroke.
• To assess the frequency of high-risk diagnoses during these pre-stroke ED visits.
• To identify potential windows for intervention and stroke prevention.

Main Methods:

• Utilized data from a population-based stroke surveillance study in South Texas (April 2003 - December 2020).
• Linked Medicare claims data to identify ED visits in the 90 days prior to physician-validated ischemic and hemorrhagic strokes.
• Employed logistic regression to analyze clinical and sociodemographic factors associated with pre-stroke ED utilization; high-risk diagnoses were manually reviewed.

Main Results:

• 2498 stroke cases were analyzed; 8.4% had a pre-stroke ED visit (4.1% had multiple visits).
• Medicaid insurance (OR 1.54) and diabetes (OR 1.73) were significantly associated with increased odds of pre-stroke ED visits.
• Of 430 total pre-stroke ED visits, 20% were for high-risk diagnoses, including neurologic symptoms (16.3%), hypertensive disorders (2.8%), and atrial fibrillation (1.2%).

Conclusions:

• Pre-stroke ED visits are frequent, particularly in patients with diabetes or Medicaid insurance.
• A significant proportion of these visits were for high-risk diagnoses, suggesting missed opportunities for stroke prevention.
• Targeted interventions during pre-stroke ED visits could improve stroke prevention and early treatment outcomes.