2023 American Academy of Neurology Abstract Website

Objective:

To assess whether patient, hospital, and pre-hospital factors may be disparities underlying stroke treatment differences between patients hospitalized with acute ischemic stroke (AIS) at academic medical centers (AMC) and those at community hospitals (CH). We hypothesize that primary language, method of transportation, and stroke code activation would be associated with differences in treatment times between AMCs and CHs.

Background:

An essential aspect of stroke care is prompt treatment after symptom onset, but systemic issues and biases can correlate with suboptimal triage and treatment. Assessing and targeting quality control to address these sources of disparity can help community and academic hospitals provide more equitable treatment to patients suffering from stroke.

Design/Methods:

We retrospectively collected data from the electronic health record at Tufts Medical Center for adult patients hospitalized with AIS between 2018-2020. We compared patients who directly presented to TMC with patients transferred from CH for further care. We performed multivariate analyses to assess whether there were disparities underlying differences in door-to-CT and door-to-needle time, method of transportation used, and stroke code activation.

Results:

542 patients were included in this analysis. There was no significant difference in median door-to-CT or door-to-needle time between the two groups. AMC white patients (OR=1.54, 95% CI 1.00-2.39) and CH Asian patients (1.40, 1.03-1.90) were more likely to utilize EMS services. CH patients with a non-English primary language were less likely to utilize EMS (0.73, 0.61-0.88). CH Asian (0.67, 0.47-0.96) and AMC (0.66, 0.44-0.97) and CH (0.70, 0.53-0.92) Hispanic patients were less likely to have stroke code activation.

Conclusions:

There are disparities in EMS utilization and stroke code activation among patients of different race/ethnicity and who speak a non-English primary language presenting at community and academic medical hospitals. Additional research is needed to assess community and hospital interventions that can diminish the role that systemic biases play in these disparities.