Abstract 17: Racial Disparities in Stroke Recognition by Prehospital Providers

Abstract

Background: African Americans and Hispanics are less likely to receive thrombolytics for acute ischemic stroke. Whether similar disparities exist in the prehospital setting for stroke recognition has not been studied. Our objective was to determine the differences in sensitivity and specificity of stroke recognition between racial/ethnic groups. Methods: This is a secondary analysis of linked prehospital and hospital based outcome data for patients presenting to hospitals within two northern California counties between 2005 and 2007. Prehospital clinical impression was obtained from the paramedic report and hospital diagnosis of stroke was identified using validated ICD- 9 codes in the discharge abstract file of the state administrative database. Patients missing data on race, ethnicity, paramedic primary impression or hospital discharge diagnosis were excluded. Sensitivity and specificity of prehospital stroke recognition among different racial/ethnic groups including Asians, Hispanics, and Non-Hispanic Whites were calculated. Independent association of race with sensitivity and specificity of prehospital stroke recognition was explored using a logistic regression model. Results: 223,318 patients were transported by EMS during the study period; 3,633 had a primary discharge diagnosis of stroke using validated ICD-9 codes. Pre-hospital sensitivity for stroke recognition was lower among Asian (OR 0.65, 95% CI 0.54-0.79) and Hispanic patients (OR 0.74, 95% CI 0.59-0.92) when compared with Non-Hispanic Whites. Female gender was also independently associated with lower sensitivity of pre-hospital recognition (OR 0.82, 95% CI 0.71-0.940). Hispanic ethnicity and female gender were all independently associated with increased specificity. Conclusion: Race/ethnic and gender disparities exist in the prehospital recognition of stroke. Future efforts should explore the effects of these differences on stroke treatment rates.