Social Vulnerability and Out-of-Hospital Identification of Neurologic Emergencies

Area of Science:

• Emergency Medicine
• Public Health
• Neurology

Background:

• Timely recognition and management of neurologic emergencies are crucial for patient outcomes.
• Social risk factors may influence emergency medical services (EMS) care quality for time-sensitive conditions.
• Understanding these disparities is vital for addressing long-term morbidity and mortality.

Purpose of the Study:

• To examine the association between community-level social vulnerability and the out-of-hospital identification of neurologic emergencies.
• To investigate how social vulnerability impacts EMS recognition of stroke, status epilepticus, intracerebral hemorrhage, and traumatic brain injury.
• To identify potential inequities in emergency care delivery based on social determinants of health.

Main Methods:

• Retrospective cohort study using the ESO Data Collaborative dataset (January 2019-December 2022).
• Included EMS encounters for patients diagnosed with specific neurologic emergencies (stroke, TBI, ICH, SE).
• Social vulnerability measured using the Social Vulnerability Index at the census tract level; primary outcome was EMS identification of the neurologic emergency.

Main Results:

• Higher social vulnerability was associated with a 33% increased risk of EMS failing to identify neurologic emergencies.
• Specific conditions affected: increased risk for stroke (31%) and traumatic brain injury (17%).
• No significant association found for status epilepticus or intracerebral hemorrhage.

Conclusions:

• Increased neighborhood social vulnerability correlates with reduced out-of-hospital identification of neurologic emergencies, especially stroke and TBI.
• Targeted strategies are necessary to ensure equitable recognition and response for time-sensitive neurologic conditions.
• Addressing social determinants of health is critical for improving emergency care outcomes.