Abstract WMP72: Onset-to-Arrival Time Varies by Race and Stroke Severity

Abstract

Introduction: Shortening onset-to-arrival (OTA) time among acute ischemic stroke (AIS) patients is an important public health goal in order to increase the proportion of patients eligible for disability-reducing treatment. Understanding factors associated with delays in OTA will help to focus educational interventions. Hypothesis: AIS patients with greater stroke severity are more likely to arrive early (OTA≤3.5 hours); and among AIS patients arriving acutely (within 8 hours), stroke severity will also predict shorter OTA time. Methods: Prospective study of all AIS patients presenting to the 60 of 70 Massachusetts hospitals participating in the Coverdell Registry from 2005-13, excluding patients transferred from another acute care facility or with symptom onset after hospital arrival. Logistic and linear regression analyses identified predictors of OTA within 3.5 hours, and predictors of shorter OTA among patients presenting within 8 hours, accounting for clustering by hospital. Results: Among 51,631 AIS patients, 6,904 patients (13.4%) were transferred or presented from another acute care facility and complete time data were documented in 82% of the remaining patients for a final sample of 36,680. Median OTA was 6.2 hours (IQR 1.2-18.8 hours). Predictors of OTA within 3.5 hours included stroke severity, younger age, male gender, race, private insurance, ambulance arrival, later year of presentation, and medical history (Table). Among the 19,831 patients arriving acutely (OTA≤8 hours), predictors of shorter OTA duration included stroke severity, non-black race, ambulance arrival, and medical history (Table). Conclusions: Black patients and patients with lower NIHSS are more likely to have delayed arrival. Future work should focus on reducing disparities in care-seeking behavior.