Abstract W P180: Sex Differences in Acute Stroke Evaluation

Abstract

Introduction: Prompt acute stroke evaluation is essential for optimal treatment. Women may receive delayed evaluation and treatment; consistent data is unavailable. We analyzed sex differences in acute stroke evaluation. Methods: We evaluated consecutive Code Stroke patients from the UCSD SPOTRIAS database, excluding inpatients. Subgroups included acute ischemic stroke (AIS) and IV r-tPA treated patients. Wilcoxon and Fisher’s Exact Test compared baseline variables between sexes. Times from onset to arrival, arrival to: stroke code, neurological exam, brain imaging, laboratory, decision, and treatment were compared between sexes using linear regression, adjusting for pre-specified covariates: age, smoking, atrial fibrillation, hypertension, glucose, baseline NIHSS, pre-stroke mRS, and onset to arrival time. Multivariable logistic regression models evaluated 90 day mRS, adjusted as above. (Good outcome: mRS 0-2) Results: Of 3,214 patients (48.3% female), women were older (p<0.0001), with more atrial fibrillation (p<0.01), and higher pre-stroke mRS (p<0.0001) compared to men. Smoking history was more common in men in all analyses (p<0.0001). Evaluation times and 90-day outcomes were similar, except women had longer arrival to neurological exam times (41.5 ± 52.8 min vs. 37.5 ± 68.9 min; p=0.014). In total, 1,476 patients had AIS (45.8% female). Of all women with Code Strokes, 43.5% were diagnosed with AIS while 48.1% of men were diagnosed. In the AIS subset, evaluation times were not significantly different, though women with AIS were more likely to have poor outcome after adjusting for pre-specified covariates (54.5% vs. 39.4%, p=0.017). There were 532 patients diagnosed with AIS and treated with tPA (49.8% female). There were no significant differences in evaluation times or 90-day outcome. Discussion: In this single center experience, evaluation and treatment times did not differ between men and women except for the time from arrival to neurological exam. While any sex based difference is concerning, further multicenter trials are needed to better understand any possible sex based stroke evaluation and treatment bias.