Abstract 29: Recurrent Stroke Arrival Time

Abstract

Introduction: All stroke patients and family members should receive stroke education including recognition of stroke symptoms and prompt activation of emergency medical (EMS). The impact of this education is unclear. We aimed to measure the association between EMS use and timing of arrival within first ever and recurrent strokes. Methodology: The study analyzed data from validated strokes identified by the Brain Attack Surveillance in Corpus Christi (BASIC) project between 1/1/2000-1/1/2020. We analyzed 5,617 first-ever strokes (FES), 259 instances of recurrent stroke within 1 year of the first (RS1), and 2,044 recurrent strokes over 1 year or unknown duration from the first (RS0). Following imputation, recurrent stroke’s associations with both EMS arrival (available post-2010) and early arrival (< 3hrs) were assessed with logistic models, accounting for clustering with generalized linear models (GEEs). Results: Compared to FES, there was significantly higher unadjusted odds of arrival by EMS, but not early arrival, for one of the recurrent stroke groups (Table 1; RS0: OR = 1.29, 95% CI=1.10-1.50; RS1:OR=1.24, CI=0.87-1.75). The association was not significant after adjustment. Increasing stroke severity, married status and EMS use were associated with higher odds of early arrival, while African Americans (AAs) had lower odds than non-Hispanic Whites (NHWs, Table 1). However, AAs did have higher odds of EMS use relative to NHWs. Those who were married and living together had lower odds of EMS use compared to those who were not. Conclusion: Our study examines the association of repeat stroke on early arrival and EMS use as a surrogate for adequate stroke education. By examining subsets, we can identify groups that would benefit from targeted education. For example, younger, non-AA patients with smaller strokes would benefit from more education on EMS use and African American patients would benefit from education related to faster recognition or urgency of presentation.