Abstract WMP41: Neighborhood Social Vulnerability is Associated With Lower Frequency of Stroke Scale Assessment Among Patients With Suspected Stroke

Abstract

Introduction: High-quality prehospital care during initial assessment by EMS providers can affect downstream care for acute stroke patients. Prehospital guidelines strongly recommend assessing suspected stroke patients with a validated stroke scale and obtaining a blood glucose level, but EMS adherence varies widely. Neighborhood socioeconomic characteristics are associated with stroke incidence and outcomes, but there is little research evaluating their relationship to quality metrics in prehospital stroke care. Hypothesis: Greater neighborhood-level social vulnerability is associated with lower frequency of stroke scale assessment and blood glucose check by EMS for patients with suspected stroke. Methods: We conducted a cross-sectional evaluation of EMS activations for suspected stroke patients in the 2019 ESO Data Collaborative. We included 911 responses where EMS documented a field impression of stroke and excluded activations from an acute health care facility. Neighborhood-level social vulnerability, using CDC’s Social Vulnerability Index (SVI), was assigned to each encounter based on pick-up location. Descriptive statistics were calculated, and mixed effects logistic regression models were fit to assess any relationship between SVI and documentation of stroke scale and blood glucose assessments, controlling for patient and event characteristics and clustering by EMS agency. Results: Among 84,411 patients with suspected stroke, 46% were male, with an average age of 71 years. Stroke scale assessment was documented in 78% of cases, and blood glucose in 88%. Compared to patients in the least vulnerable SVI quartile, those in the most vulnerable SVI quartile had lower odds of documented stroke scale assessment (OR 0.91, 95% CI 0.82, 1.00, p=0.04), but similar odds of documented blood glucose (OR 0.97, 95% CI 0.89, 1.06, p=0.48). High agency-level variation was present for stroke scale (ICC 70%, 95% CI 69, 73). Conclusions: Higher social vulnerability areas may be associated with less frequent stroke scale assessment; however, high agency-level variation indicates that the best targets to improve EMS systems’ compliance with evidence-based guidelines for acute stroke care may be low-performing agencies, regardless of setting.