McKay Hanna1, Henry Sam1, Mathew Gregoski1, Ashley Wabnitz1, Sami Al Kasab1, Katharine Larson1, Christine Holmstedt1, Parneet Grewal1
1Medical University of South Carolina
Objective:
Retrospectively analyze data from the tele-stroke network for sex differences in stroke care processes at spoke sites to identify disparities in treatment times and outcomes between men and women.
Background:
The structure of the stroke care delivery system in rural South Carolina has been changed by tele-stroke with >40 spoke sites with improved treatment times and outcomes, but disparities at level of primary stroke centers and acute stroke ready hospitals have not been well studied.
Design/Methods:
Data was analyzed for 21,549 patients between 1/1/2012 and 12/31/2022 for whom a telestroke was paged out. Analysis was completed using SPSS version 28 (IBM corporation, Armonk, NY). Continuous outcomes were assessed using independent samples median tests and categorical variables were assessed using X².
Results:
Of 10,713 (49.7%) males and 10,836 (50.3%) females, females were older (68.29±15.5 vs 66.09±13.7, p<0.01) and more likely to be to be African American (20.4% vs16.8%, p<0.05) compared to males. Females were more likely to get thrombolytics (29.06% vs 27.2%, p<0.05) but there was no difference in endovascular therapy between both sexes. Treatment times showed door-to-registration (F: 18±27 vs M: 17±26, p<0.05) and door to telestroke page timing (F: 22±27 vs M: 20±26, p<0.05) was higher in females compared to males with door-to-needle time having the expected disparity between men and women (F: 59±36 vs M: 55±35, p<0.05). Women also had significantly higher mean discharge NIHSS (M: 4.17±6.20 vs F: 4.61±6.70 (p<0.001) and mRS score (M:2.24±1.93 vs F:2.43±1.95 (p<0.001)). More males were discharged home (62.4% vs 60.4%, (p<0.001) and more females were discharged to nursing home (8.1% vs 6.2%, p<0.001) and hospice (3.9% vs 2.9%, p<0.001).
Conclusions:
Females are older at the time of stroke onset, have longer times to treatment, poorer outcomes and discharge dispositions. Findings highlight the opportunities to ameliorate sex disparities in developing telestroke networks in the United States.