Abstract TP160: Use Of Tele-stroke In A Large Integrated Healthcare System Demonstrate No Disparities In Endovascular Treatment For Stroke

Abstract

Background: Race and sex disparities have been reported in endovascular stroke treatment, the most effective treatment to prevent long-term disability from stroke associated with large vessel occlusion (LVO). In this study, we sought to determine if there are racial and sex disparities in endovascular stroke treatment for patients with acute ischemic stroke due to LVO across 21 community hospitals, part of an integrated delivery system, using a centralized telestroke service and standardized process for rapid stroke evaluation and treatment. Methods: Study population included patients seeking care for suspected acute stroke that were diagnosed with a LVO at one of 21 Northern California Emergency Departments between January 1, 2016 and December 31, 2019. Patients were excluded if they were less than 18 years of age or had a canceled stroke alert. Logistic regression (SAS proc genmod) was used for multivariate models. Results: Of 1519 patients with LVO, 918 underwent endovascular treatment. There were no differences in sex, Healthcare membership (yes or no), or race in patients that received endovascular stroke treatment compared to those that did not in the multi-variate models (Table). As expected, increased age, greater initial NIHSS (greater than 6), arrival by Emergency Medical Service (yes or no), and shorter time to ED arrival were associated with increased treatment rates (Table). There were no significant differences by race or sex. There were no differences in 90-day mortality rates by race (p=0.085). Non-treatment was primarily associated with patient/family refusal and or poor functioning at baseline. Conclusions: Implementation of the telestroke plus standardized workflows within all facilities provided equitable care regarding race and gender on endovascular treatment odds.