Abstract WP306: Disparities in Stroke Code Activation Times

Abstract

Background: Early activation of the stroke code system allows for rapid treatment and potentially better outcomes. Multiple disparities have been identified in standard time metrics of acute stroke care. The purpose of this study was to determine if hospital arrival to stroke code activation (SCA) time was significantly different based on age, sex, or race/ethnic differences in an academic, Comprehensive Stroke Center. Methods: We retrospectively assessed prospectively collected data from the UCSD Stroke registry from June 2003 to July 2019 for all patients for whom a stroke code was activated. Stroke code time metrics, demographics, initial and final diagnosis, treatment, medical history, baseline vital signs, and baseline NIHSS were assessed. Continuous variables were assessed by Spearman rho, Pearson correlation and t test. ANOVA was used for ordinal variables. A linear regression model was built in a stepwise method. Analysis were done unadjusted and adjusted for baseline NIHSS and baseline blood glucose. Results: Of the 5,881 total subjects, 2,954 had a final diagnosis of stroke. The overall mean age was 66.4 (18-103 years, SD 16.7) and 69.1 (18-103 years, SD 15.4) for subjects with final diagnosis of stroke. The overall mean time to SCA was 5.2 minutes (-20 to 5,746, SD 124.5). Arrival to SCA was not significantly different with respect to age in unadjusted (rs=-0.13, p=0.08) and adjusted (rs=-0.14, p=0.46) analysis. Time was not significantly different with respect to sex in both unadjusted (p=0.30) and adjusted (p=0.24) analyses. Arrival to SCA time was not significantly different with respect to race in both unadjusted (p=0.99) and adjusted (p=0.99) analyses. Arrival to SCA time was not significantly different with respect to Hispanic ethnicity in both unadjusted (p=0.09) and adjusted (p=0.07) analysis. In a linear regression model, arrival by ambulance (t 3.10, p<0.001) was the only independent predictor of arrival to SCA time. Conclusion: There were no significant differences in time to SCA based on sex, age, or race at our academic, Comprehensive Stroke Center. Arrival by ambulance was the only independent predictor of lower arrival to SCA times. Protocols and education in acute stroke management in this setting have reduced disparities in SCA.