Abstract HUP10: Sex Disparities In A Telestroke Network: From Treatment Times To Outcomes

Abstract

Background: The structure of the stroke care delivery system in rural South Carolina has been changed by the Medical University of South Carolina tele-stroke program with >40 spoke sites with improved treatment times and outcomes overall. Disparities at the level of primary stroke centers and acute stroke ready hospitals have not been well studied. The aim of this study is to 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. Methods: Data was collected and analyzed for 21,549 patients between 1/1/2012 and 12/31/2022 for whom a telestroke was paged out. Statistical analysis was completed using SPSS version 28 (IBM corporation, Armonk, NY). Variables with continuous outcomes were assessed using independent samples median tests and categorical variables were assessed using X 2 . 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) as compared to males. Females were more likely to get thrombolytic therapy (29.06% vs 27.2%, p<0.05) but there was no difference in endovascular therapy between both sexes. Treatment times showed that door-to-registration timing (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 significantly higher in females compared to males with ultimately 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) post admission. Conclusions: Females are older at the time of stroke onset, have longer times to treatment and poorer outcomes and discharge dispositions. Our findings highlight the opportunities to ameliorate sex disparities in developing telestroke networks in the United States. Future studies should target these disparities to improve outcomes.