Abstract
Introduction: It has been found that women are disproportionately affected by stroke when compared to men. This can be partially attributed to the presence of non-traditional stroke symptoms in women but also sex variance in stroke care. The FAST-ED is a prehospital initiative used to triage patients presenting with typical stroke symptoms and serves as a proxy for stroke severity directing EMS transportation to the appropriate care center. This study explored sex discrepancies in our community’s prehospital stroke initiative and its effects on patient care. Methods: An internal hospital registry created in 2017 evaluated EMS FAST-ED compliance and monitored the effects on patient outcome. This database contains two existing cohorts; one cohort prior to FAST-ED implementation and one cohort after implementation. Using this data set we added another cohort of cases 2-years after implementation. The inclusion criteria consisted of patients ≥18 years, arriving via EMS as stroke alerts. No exclusion criteria were included in this study. Variables that were evaluated for sex differences included EMS FAST-ED compliance, FAST-ED score, final diagnoses, door-to-needle DTN and door-to groin DTG, and stroke treatment volumes. Results: A total of 1419 cases were included in the dataset with 55% (n=781) being women. EMS FAST-ED compliance was 80.6% for men and 78.7% for women. The average FAST-ED score did not statistically differ between men (M=3.34, SD=2.34) and women (M=3.30, SD=2.25). There was also no sex difference in stroke treatment times or volumes. In this study, the only significant sex difference was in the final diagnoses’ code, where women were 54% (95CI: 51%-58%) CI) more likely to have CVA, 71% (95CI: 51%-88% CI) more likely to have a SAH, and 65% (95CI: 56%-74%) more likely to have a TIA when compared the men. Discussion: The results of this study did not show sex differences in the pre-hospital approach to stroke care in our community. Specifically, no difference in stroke EMS triage, stroke treatment times (DTN and DTG), or stroke treatment volumes. Our findings regarding sex differences in final stroke diagnoses code deserves further study.
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