Abstract
Introduction: Prior studies have documented disparities in key acute stroke care metrics, with women and minorities more likely to have treatment delays and less likely to receive IV tPA. Objective: To evaluate whether implementation of a direct ambulance-to-CT stroke protocol reduces race, sex, and primary language disparities in stroke treatment times. Methods: We identified patients with confirmed strokes that had been transported by ambulance to our emergency department before and after implementation of a direct ambulance-to-CT protocol for suspected stroke at our urban safety-net hospital. We used the Mann-Whitney U test to compare median door-to-CT (DTC) and door-to-needle (DTN) times by sex, race, and primary language during the pre- and post-intervention periods. Results: A total of 106 stroke patients in the pre-intervention group and 119 in the post-intervention group were included in this analysis. The pre-intervention group included 57 (53.8%) women, 20 (18.9%) whites, and 68 (64.2%) English-speaking patients. The post-intervention group included 58 (48.7%) women, 26 (21.9%) whites, and 77 (64.7%) English-speaking patients. A total of 48 pre-intervention patients and 47 post-intervention patients received tPA. Overall, median DTC and DTN times were significantly lower in the post-intervention group compared to the pre-intervention group (21 minutes vs. 10, p<0.0001; 39 vs. 30, p=0.006). There were no significant differences in DTC or DTN times by sex, race, or primary language in the pre-intervention group, but women had longer median DTN times than men (34 vs. 24, p=0.02) in the post-intervention group. Conclusions: While no significant disparities in stroke treatment times by sex, race, or primary language were identified in the pre-intervention period, implementation of a direct ambulance-to-CT protocol was associated with greater improvements in DTN times for men than for women.
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