Abstract WP226: Predictors of Delayed Hospital Arrival After Onset of Stroke Symptoms in Black and Hispanic Stroke Survivors

Abstract

Introduction: Delayed hospital arrival (DHA) after onset of stroke symptoms often precludes minority stroke victims from life-saving interventions. We sought to identify predictors of DHA in a cohort of Black and Hispanic stroke survivors. Methods: We analyzed data from a clinical trial comprising Blacks and Hispanics with recent stroke recruited from New York City stroke centers. Variables associated with pre-hospital behaviors were abstracted from medical records. DHA was defined as arrival to ER >4.5 hours after symptom onset. A GEE model assuming a binomial distribution with a logit link was used in all multivariate analyses adjusting for demographic variables, recurrent stroke, stroke severity, stroke symptomatology, stroke type, being alone at symptom onset, and mode of transportation. Results: Data was available for 209 Hispanics and 202 Blacks. The sample was 44% female with average age 61.9±11.0 years. Annual income was reported to be <$15,000 in 50% of participants, while 42.2% reported less than high school education. The index stroke was a recurrent stroke in 35.4% of participants and 75.8% were ischemic. Motor symptoms were the predominant symptom (45.7%). Average baseline stroke severity (NIHSS score) was 4.5±4.8. Majority of participants (64.0%) reported being alone at symptom onset and a minority were transported by EMS (35.5%). The frequency of DHA was 76.4%. Use of EMS was associated with a decreased likelihood of DHA (OR=0.17, 95% CI=0.10-0.31). Being alone at symptom onset was associated with increased likelihood of DHA (OR=2.49, 95% CI=1.36-4.55). DHA was not associated with race/ethnicity, education or recurrent stroke. There was a decreased likelihood of EMS use if: 1) participant was alone at symptom onset (OR=0.19, 95% CI=0.11-0.34), and 2) if stroke symptoms were sensory in nature (OR=0.11, 95% CI=0.03-0.44). Conclusions: The frequency of DHA is high and is associated with a failure to activate EMS. The failure to activate EMS may be related to the experience of non-motor symptoms and is associated with being alone during symptom onset. Stroke education efforts should emphasize development of an action plan for alerting EMS that can be implemented when alone and emphasize that stroke symptoms are often non-motor in nature.