Stroke Symptoms Research Articles

Facial expressions to identify post-stroke: A pilot study

Background and Objective:Timely stroke treatment can limit brain damage and improve outcomes, which depends on early recognition of the symptoms. However, stroke cases are often missed by the first respondent paramedics. One of the earliest external symptoms of stroke is based on facial expressions. Methods:We propose a computerized analysis of facial expressions using action units to distinguish between Post-Stroke and healthy people. Action units enable analysis of subtle and specific facial movements and are interpretable to the facial expressions. The RGB videos from the Toronto Neuroface Dataset, which were recorded during standard orofacial examinations of 14 people with post-stroke (PS) and 11 healthy controls (HC) were used in this study. Action units were computed using XGBoost which was trained using HC, and classified using regression analysis for each of the nine facial expressions. The analysis was performed without manual intervention. Results:The results were evaluated using leave-one-our validation. The accuracy was 82% for Kiss and Spread, with the best sensitivity of 91% in the differentiation of PS and HC. The features corresponding to mouth muscles were most suitable. Conclusions:This pilot study has shown that our method can detect PS based on two simple facial expressions. However, this needs to be tested in real-world conditions, with people of different ethnicities and smartphone use. The method has the potential for a computerized assessment of the videos for use by the first respondents using a smartphone to perform screening tests, which can facilitate the timely start of the treatment.

Rapid Intravenous Glyceryl Trinitrate in Ischemic Damage (RIGID): A potential neuroprotection strategy for acute ischemic stroke (AIS) patients

Despite advances in intravenous thrombolysis and endovascular thrombectomy, numerous acute ischemic stroke survivors continue to experience various disability levels. The nitric oxide (NO) donor, Glyceryl Trinitrate (GTN), has been identified as a potential neuroprotective agent against ischemic damage. We evaluated the safety and feasibility of intravenous GTN in AIS patients. Subsequently, we conducted a secondary analysis to assess for possible efficacy of GTN as a neuroprotectant. We conducted a prospective, double-blind, randomized controlled trial in the Stroke Intervention & Translational Center (SITC) in Beijing Luhe Hospital, Capital Medical University (ChiCTR2100046271). AIS patients within 24 h of stroke onset were evenly divided into GTN or control groups (n = 20 each). The GTN group received intravenous GTN (5 mg in 50 ml saline at a rate of 0.4 mg/h for 12.5 h/day over 2 days), while controls were administered an equivalent volume of 0.9% saline. Both groups followed standard Stroke Guidelines for treatment. Safety measures focused on SBP<110 mmHg and headache occurrence. Efficacy was assessed via the 90-day modified rankin score (mRS) and the national institutes of health stroke score (NIHSS). Of the 40 AIS patients, baseline characteristics such as age, gender, risk factors, and pre-mRS scores showed no significant difference between the groups. Safety measures of SBP<110 mmHg and headache occurrence were comparable. Overall, 90-day mRS (1 vs. 1) and NIHSS (1 vs. 1) did not significantly differ between groups. However, the GTN-treated group had a benefit in enhancing NIHSS recovery (△NIHSS 4.5 vs. 3, p = 0.028), indicating that GTN may augment recovery. Subgroup analyses revealed a benefit in the GTN group at the 90-day NIHSS score and △NIHSS follow up for non-thrombolysis patients (1 vs. 2, p = 0.016; 5 vs. 2, p = 0.001). Moreover, the GTN group may benefit mild stroke patients in NIHSS score at 90 day and △NIHSS observed at 90 days (1 vs. 1, p = 0.025; 3 vs. 2 p = 0.002). Overall, while preliminary data suggest GTN might aid recovery in NIHSS improvement, the evidence is tempered due to sample size limitations. The RIGID study confirms the safety and feasibility of intravenous GTN administration for AIS patients. Preliminary data also suggest that the GTN group may provide improvement in NIHSS recovery compared to the control group. Furthermore, a potential benefit for non-thrombolysis patients and those with mild stroke symptoms was identified, suggesting a possible potential role as a tailored intervention in specific AIS subgroups. Due to the limited sample size, further larger RCT will be necessary to replicate these results. Trial Registrationwww.chictr.org.cn, identifier: ChiCTR2100046271.

PEMBERDAYAAN MASYARAKAT DALAM UPAYA PENCEGAHAN STROKE DI KELURAHAN TARATARA SATU

About a third of stroke sufferers in the world experience permanent disability. Stroke occurs when the brain's blood vessels fail to supply oxygen to the brain cells or when the brain cells do not receive nutrients and oxygen from the blood. Stroke symptoms usually appear suddenly, with loss of strength on one side of the body, confusion, difficulty speaking and understanding, problems with vision, difficulty walking, headaches, and loss of balance. This can be prevented from happening by adopting a healthy lifestyle. The service method used is the lecture and question and answer method with people who are at risk of stroke. The result of this service activity is that there has been an increase in public knowledge about stroke prevention, which is the result of this service activity. This activity is also very important to carry out, especially targeting people with hypertension who are no longer able to comply with taking anti-hypertension medication and adopting a healthy lifestyle, so they need to provide education or socialization about stroke prevention.

Pediatric Ischemic Stroke: Clinical and Paraclinical Manifestations—Algorithms for Diagnosis and Treatment

Childhood stroke can lead to lifelong disability. Developing algorithms for timely recognition of clinical and paraclinical signs is crucial to ensure prompt stroke diagnosis and minimize decision-making time. This study aimed to characterize clinical and paraclinical symptoms of childhood and neonatal stroke as relevant diagnostic criteria encountered in clinical practice, in order to develop algorithms for prompt stroke diagnosis. The analysis included data from 402 pediatric case histories from 2010 to 2016 and 108 prospective stroke cases from 2017 to 2020. Stroke cases were predominantly diagnosed in newborns, with 362 (71%, 95% CI 68.99–73.01) cases occurring within the first 28 days of birth, and 148 (29%, 95% CI 26.99–31.01) cases occurring after 28 days. The findings of the study enable the development of algorithms for timely stroke recognition, facilitating the selection of optimal treatment options for newborns and children of various age groups. Logistic regression serves as the basis for deriving these algorithms, aiming to initiate early treatment and reduce lifelong morbidity and mortality in children. The study outcomes include the formulation of algorithms for timely recognition of newborn stroke, with plans to adopt these algorithms and train a fuzzy classifier-based diagnostic model using machine learning techniques for efficient stroke recognition.

Awareness Regarding Risk Factors, Signs and Symptoms and Treatment of Stroke

Background: The awareness of risk factors, signs and symptoms and treatment of stroke is important to reduce morbidity and mortality in India and may lead to better functional outcome and quality of life for the patient. This study was conducted to assess the level of awareness of stroke in the general population of Pune. Materials and methods: Ethical committee clearance was taken. A sample of 201 participants from Pune and nearby regions, India participated in this cross sectional study. Data was collected via Google forms and further analyzed. Results: The average age of the study participants was 30.29 with SD OF 12.53 yrs, out of which 60.2% were males and 39.3% were females. Most commonly recognised risk factors in this study were hypertension and stress (71.6%). Only 4.2% participants were able to identify all the risk factors correctly. Most identified sign was chest pain (64.2%) followed by loss of balance (55.7%). 56.7% recognized the brain as the part affected. In terms of emergency response, there was a high level of awareness regarding the importance of calling an ambulance (76.1%). 86.57% knew at least two correct measures for prevention of stroke. Only 47.8% were aware about the achievable recovery post stroke Conclusion: There is significant lack of awareness about risk factors and signs and symptoms of stroke. Public awareness can be done by conducting seminars and via online social media platforms to target young age groups.

Evaluation of Approaches for Early Stroke Detection and Diagnosis Using EMG Data: Features, Techniques, and Challenges

This paper provides a thorough analysis of the use of electromyography (EMG) data in early stroke diagnosis and detection. Stroke continues to be a major global cause of disability and death, which emphasises the critical need for an accurate diagnosis made quickly to improve patient outcomes. Early detection is still difficult to achieve, even with improvements in medical imaging and testing technologies. By detecting minute variations in muscle activity linked to stroke symptoms, EMG data analysis offers a viable method for early stroke identification. The review delves into the diverse methodologies and strategies utilised to leverage EMG data for the purpose of stroke diagnosis, encompassing the application of deep learning models and machine learning algorithms. The paper proposes a structured framework for classifying approaches for early stroke detection and diagnosis using EMG data, providing a systematic way to categorize and compare different methodologies. The paper concludes by highlighting the revolutionary potential of EMG-based techniques in improving the diagnosis of strokes earlier and urging more study to address current issues and make clinical application easier.

Knowledge and self-perceived competence about cardiopulmonary resuscitation among youths: a cross-sectional study in a sample of Italian undergraduates.

Cardiopulmonary resuscitation is fundamental to improve the outcomes of a life-threatening event. The correct knowledge of first aid actions to provide may guarantee the victim's survival. This study was aimed at evaluating the competence about cardiopulmonary resuscitation and its predictors in a sample of Italian undergraduate students. Information on socio-demographic characteristics, first aid training, knowledge of stroke and heart attack symptoms and perceived ability to provide first aid, were collected through a web-based questionnaire. On a total of 744 respondents (mean age 23.9±5.4 years, 62.5% female), 71.4% identified correctly first aid actions, 59.9% and 60.8% showed a good knowledge of stroke and heart attack symptoms, respectively. However, only 39.0% of them declared their ability to intervene in case of emergency. Attending a healthcare degree course and having had first aid training were associated with knowledge of symptoms and perceived ability to provide first aid. Female gender was negatively related with perceived ability to intervene. In spite of the satisfactory level of knowledge, these findings highlight the need to enhance the competence about cardiopulmonary resuscitation in the lay population, especially among females.

Post-stroke emotionalism: Diagnosis, pathophysiology, and treatment.

Post-stroke emotionalism affects one in five stroke sufferers 6 months after their stroke, but despite its frequency remains a poorly understood stroke symptom. The literature is limited, especially compared to other frequently observed neurological conditions such as aphasia and visual neglect. This narrative review presents a summary of the post-stroke emotionalism literature, to inform clinical practice and future research. We cover discussion of definitions, prevalence, neurobiology, predisposing and precipitating factors, and treatment. Increasing evidence suggests that damage to specific areas functionally linked to emotion expression or regulation processes, disruption to structural pathways and those related to serotonin production and modulation individually or in concert give rise to emotionalism-type presentations. A range of emotionalism measurement tools have been used in research contexts making between study comparisons difficult. Testing for Emotionalism after Recent Stroke-Questionnaire (TEARS-Q) has recently been developed to allow standardized assessment. Treatment options are limited, and there have been few adequately powered treatment trials. Antidepressants may reduce severity, but more trial data are required. There have been no randomized-controlled trials of non-pharmacological interventions. More research is needed to improve recognition and treatment of this common and disabling symptom. We conclude with research priorities and recommendations for the field.

Methods for Detecting Early Symptoms of Stroke: A Literature Review

Background: In the world every 2 seconds 1 person suffers from a stroke, and 16% of the world's population experiences a stroke in their lifetime, every 4 seconds 1 person dies. The initial symptoms of a stroke must be recognized quickly until the stroke patient's golden period of 4.5 hours is over so that there is no wider damage to brain tissue due to a lack of oxygen for too long which causes brain cells (neurons) to die and connections or connections between neurons (synapses) to be lost. can cause paralysis, blurred vision, difficulty speaking, decreased consciousness and even death. Objectives: To analyze the Early Symptom Detection Method of Stroke. Methods: The authors conducted a PRISMA-style systematic review of Stroke Early Symptom Detection Methods in various countries. Using five articles that were used and then included for analysis and interpretation. Results: There are two methods for early detection of early symptoms of stroke that can be used to detect early symptoms of stroke, namely F.A.S.T and BE-FAST. Both methods have the same accuracy and have an optimal limit for detecting stroke of ≥1. Conclusion: There are two methods for early detection of early symptoms of stroke that can be used to detect early symptoms of stroke, namely F.A.S.T and BE-FAST, for this reason these methods need to be disseminated to the public. So it has the impact of being able to increase knowledge about stroke symptom detection which can increase timely stroke detection before the golden period ends.

Stroke Awareness and Knowledge in the At-Risk Population: A Community-Based Study.

The BE-FAST (balance, eyes, face, arms, speech, and time) mnemonic helps to identify stroke symptoms, which has been publicized through social media in Thailand for a while. Timely access to medical care enhances the likelihood of receiving efficacious treatment, thereby mitigating the adverse consequences of the stroke. Thus, stroke awareness in the general population, especially in the population at risk, is crucial. The purpose of the study was to evaluate stroke awareness and the level of knowledge about stroke in Thailand. Adult participants aged at least 40 years, without a history of stroke, were included, with exclusions limited to those unwilling to participate. Data were gathered from the survey during two community visits and through an electronic survey via Google Forms (Google LLC, Mountain View, California, United States). A pre-tested questionnaire was divided into three parts: symptoms of acute stroke, vascular risk factors, and response. Demographics were compared between participants with good and poor knowledge of stroke awareness. A total of 281 participants were included, with a mean age of 58 years and 60% (n=169) of participants having at least one vascular risk factor. Of the responders,133 (47%) had good knowledge of stroke awareness. Older age (age > 50 years, OR 0.326, 95%CI 0.173-0.615, p-value = 0.001), higher education (> 6 years, OR 0.266, 95%CI 0.139-0.508, p-value < 0.001)), and being female (OR 0.474, 95%CI 0.252-0.891, p-value = 0.020) were related to good stroke knowledge. Participants with good knowledge of stroke awareness also had good knowledge of vascular risk factors (84%; n=112), knew that they should come to the hospital immediately (74%; n=98), and also correctly identified the emergency calling number (90%; n=119). Only half of the participants had good knowledge of stroke awareness. There is a need for improvement in the distribution of knowledge about stroke in Thailand.

221 Submaximal Angioplasty Alone Versus Stenting Plus Angioplasty for Symptomatic Intracranial Atherosclerotic Disease a Propensity Score Matched Comparative Study With Long Term Follow-Up

INTRODUCTION: Symptomatic intracranial atherosclerotic disease (ICAD) remains an important cause of recurrent stroke and acute ischemic event. Although the high periprocedural risk of intracranial stenting from recent randomized studies has dampened enthusiasm for such interventions, submaximal angioplasty without stenting may represent a safer endovascular treatment option. METHODS: A prospectively maintained database was retrospectively searched for patients presenting with signs and symptoms of acute ischemic stroke or transient ischemic events. Patients subsequently underwent CT Stroke Study to confirm the diagnosis of symptomatic intracranial atherosclerotic disease. Patient baseline demographic characteristics, procedural details and post-procedure outcomes were recorded. A one-to-one matched propensity score analysis was performed to adjust for treatment selection bias using the nearest-neighbor matching technique without replacement for covariates (baseline comorbidities, previous stroke or TIA, antiplatelet use, anticoagulant use, and baseline percent diameter stenosis). Mann-Whitney U test was performed to compare the procedural parameters and the clinical outcomes between groups. RESULTS: We included 218 patients (Submaximal angioplasty:97 [97 after PSM]; Stenting plus angioplasty:121 [97 after PSM]). After PSM, no difference was seen between the two groups in terms of comorbidities, and initial stroke severity. Submaximal angioplasty group had significantly lower incidence of stroke/TIA secondary to restenosis on follow-up (6.2% vs. 20.6% (OR = 0.87; P = 0.003)), and longer length of follow-up after discharge (4.17 years vs. 2.88 years (OR = 0.98; P = 0.03)) when compared to stenting plus angioplasty group. Both groups had similar rates of intra- (2.1% vs. 6.2% (OR = 0.96; P = 0.15)) and post-procedural complications rates (6.2% vs. 11.3% (OR = 0.95; P = 0.21)). CONCLUSIONS: Submaximal angioplasty alone results in better long-term clinical outcomes in terms of stroke/TIA when compared with stenting and angioplasty for symptomatic intracranial atherosclerotic disease, and represents a potentially promising intervention.

Prediction of Oral Intake at Discharge with Early Assessment of Swallowing Function within 24h after Admission: A Retrospective Cohort Study.

Dysphagia is one of the most common symptoms of stroke and can lead to other complications such as pneumonia, dehydration, and malnutrition. This retrospective cohort study evaluated the predictive value of a comprehensive swallowing assessment tool, the Mann Assessment of Swallowing Ability (MASA), in the acute phase of stroke for oral intake status at discharge. Among 1,133 consecutive patients with acute stroke, 512 patients whose swallowing function was assessed using the MASA within 24h of admission were included. Data including demographic information, stroke severity, MASA, Oral Health Assessment Tool, body mass index, and serum albumin level were collected. Predictive factors for oral intake were analyzed using a multiple logistic regression model, and the receiver operating characteristic (ROC) curve analysis was used to determine the cutoff values of the MASA score for determining oral intake at discharge. Oral intake at discharge was established in 69.1% of the cohort (354/512). The multiple logistic regression analysis identified a higher MASA score, younger age, and higher serum albumin level as significant predictors of oral intake at discharge. The cutoff value of the MASA score for oral intake was 136.5 points, with an area under the ROC curve of 0.87. These findings suggest that the MASA is a valid tool for predicting oral intake in patients with dysphagia during the acute phase of stroke.

705 Urgent or Emergent Endovascular Intervention for Neurological Deficits Post-carotid Endarterectomy: A Single-institutional Case Series and Systematic Review of the Literature

INTRODUCTION: Historically the management of acute neurological deficit following carotid endarterectomy (CEA) has been operative re-exploration; however, given the proliferation of endovascular techniques, and utilization of CT angiography, endovascular intervention is an alternative to redo-CEA. METHODS: All patients undergoing CEA in the Department of Neurosurgery at Rhode Island Hospital (Providence, RI) were reviewed. A systematic literature review was conducted in PubMed according to PRISMA guidelines to identify papers relevant to endovascular procedures addressing acute neurological deficits following CEA, which yielded 2499 unique articles. Review by 2 investigators revealed 12 relevant articles. RESULTS: Four patients from our institutional cohort met inclusion criteria. Among these, stenting was technically successful in 3 patients, 2 of which achieved near-full recovery. One patient underwent successful carotid stenting and ipsilateral M2 thrombectomy for tandem occlusion. Stent placement was unsuccessful in the remaining patient due to mechanical constriction. Articles obtained through the literature review revealed 57 further relevant cases. Of those with sufficiently complete data, 30/39 (76.9%) were male with an age range of 43 - 78 years old. Twenty-eight of 32 (87.5%) patients underwent CEA for symptomatic carotid stenosis. Post-CEA angiographic evaluation was most commonly conducted for routine completion imaging (21/57, 36.8%), non-specific stroke symptoms (15/57, 26.3%), and extremity weakness (7/57, 12.3%). Thrombotic stenosis (23/43, 53.4%) and arterial dissection (15/43, 34.9%) were the most common angiography findings. Two (3.5%) stent procedures were unsuccessful, and in the immediate postoperative period 8 patients (14.0%) had significant neurological deficits and only 3 deaths (5.3%) were reported. CONCLUSIONS: Endovascular intervention may be considered in situations where patients have neurological deficit after CEA. Direct comparison of outcomes in patients who have endovascular intervention vs. redo CEA may help identify the optimal management strategy.

Developing Systems of Care for Stroke in Resource-limited Settings.

Although stroke prevention and treatment strategies have significantly advanced in recent years, implementation of these care elements in resource-limited settings can be challenging, since the burden of stroke is higher and access to stroke care is lower. Barriers to stroke care in resource-limited settings include insufficient prevention, reduced awareness of stroke symptoms, limited prehospital care and lack of triage systems, limited access to comprehensive stroke centers, inadequate personnel education, lack of staff and resources, as well as limited access to neuroimaging, thrombolytics, mechanical thrombectomy, neurosurgical care, and rehabilitation. Here, we suggest strategies to improve stroke care in these settings, including public health campaigns, protocols for prehospital notification, organized flow to specialized stroke centers, development of dedicated stroke units, and utilization of telemedicine and telerehabilitation. We also highlight the role of international organizations and governments in reducing the global burden of stroke.

The precision by the Face Arm Speech Time (FAST) algorithm in stroke capture, sex and age differences: a stroke registry study

BackgroundThe shift towards milder strokes and studies suggesting that stroke symptoms vary by age and sex may challenge the Face-Arm-Speech Time (FAST) coverage. We aimed to study the proportion of...

Onset-To-Door and Cognitive Function in Ischemic Stroke patients

Stroke could cause a decrease in cognitive function. Early diagnosis and prompt treatment play an important role in preventing the advancement of the disease. This study was aimed to determine the correlation between onset-to-door and cognitive function in ischemic stroke patients. This research was conducted in 31 ischemic stroke patients. Data collected from medical records and cognitive function examinations were measured using the Mini-Mental State Examination (MMSE). Onset-to-door (OTD) was the period from the first onset of symptoms of ischemic stroke to getting help in the emergency room Dr Ramelan naval hospital, which was divided into two groups: the golden period and non-golden period. Data were analyzed using Somer’s d correlation and Mann-Whitney U test. The results of majority (67.7%) of ischemic stroke patients had OTDin the golden period and 45.2% hadno cognitive impairment. Correlation test between OTD and cognitive function showed d = 0.576, p = 0.001. Orientation and language function were found to be different between golden period and non-golden period groups (p = 0.020 and p = 0.001, respectively). It was concluded that onset-to-door is associated with impaired cognitive function in ischemic stroke patients, especially in orientation and language function.

Recognition of Early Cardiovascular Disease Symptoms in Hypertensive and Dyslipidemic Individuals of Icheon, Korea: Insights into Educational Levels and Health Literacy.

The study aimed to explore the relationship between the presence of hypertension or dyslipidemia and the recognition of early symptoms of cardiovascular diseases (CVD), particularly acute myocardial infarction (AMI) and stroke. It is crucial for individuals with hypertension or dyslipidemia to recognize early symptoms of AMI and stroke, as timely and appropriate intervention can lead to favorable health outcomes. The study enrolled 104 participants aged 19 and above who are current residents of the Icheon region, Gyeonggi, Korea. The assessment of early symptoms of AMI and stroke utilized adapted items from the Korea Community Health Survey. In consideration of health literacy and education attainment, logistic regression analyses were conducted. While there was no significant association between hypertension and awareness of AMI or stoke symptoms, individuals with dyslipidemia demonstrated enhanced recognition of specific AMI symptoms, such as 'sudden chest pain or pressure' and 'sudden feeling of breathlessness'. No significant associations were observed between hypertension or dyslipidemia and awareness of stroke symptoms. The study emphasized the significance of targeted health education programs for individuals with chronic conditions to enhance their awareness of early symptoms of AMI and stroke.

Giant Left Atrial Myxoma Revealed by Neurological Manifestation in a Young Female Patient

Cardiac myxoma is a prevalent benign neoplasm that arises inside the cardiac tissue and exhibits a gradual growth pattern. The annual incidence rate of cardiac myxoma is approximately 0.5–1 cases per 1,000,000 persons. The fragmentation of a cardiac tumor may be influenced by cerebrovascular events. Ischemic stroke is a relatively infrequent occurrence in pediatric populations and can occasionally be attributed to cardiac myxoma. In instances of ischemic stroke, neurological impairments are observed as a result of emboli or thrombi originating from the myxoma. Echocardiography is a valuable tool for promptly diagnosing myxoma and facilitating immediate surgical removal of the myxoma. We report a 17 years old female with neurological deficit weakness in the upper and lower right extremities since 2 months ago as the chief complaint with intermittent shortness of breath. Haemodynamic parameters was stable. The patient underwent brain imaging with result a lesion of the left lentiform nucleus, transthoracic echocardiography and trans esophageal echocardiography with oscillating septated mass on left atrial, attached to the anterior mitral leaflet (AML). Primary cardiac tumors are a very uncommon cause of cardiac embolic events. An atrial myxoma, a benign growth, can form on either the left or right side of the upper part of the heart. Untreated atrial myxoma can lead to adverse effects such as arrhythmia, pulmonary edema, and emboli formation that obstruct blood flow in the heart's veins. Ischemic stroke causes a specific functional impairment. Neurological symptoms in stroke can be an extra cardiac manifestation of atrial myxoma. The use of transthoracic and tran seso phageal is important in diagnosing atrial myxoma.

The Effect of Biological Sex on a County Pre-hospital Stroke Initiative

Background Females are disproportionately affected by strokes when compared to males. This may be attributed to non-traditional stroke symptoms in females and stroke care sex variance. This study explored sex and ethnicity discrepancies in the FAST-ED and stroke outcomes. Methods An internal hospital registry created in 2017 evaluated EMS FAST-ED compliance and monitored patient outcomes. We assessed two cohorts, the 2017 cohort collected one year after FAST-ED implementation, and the 2019 cohort collected two years after FAST-ED implementation. Inclusion criteria included patients aged ≥18 years arriving via EMS as a stroke alert; walk-ins were excluded. EMS FAST-ED compliance, FAST-ED score, final diagnoses, door to needle time (DTN), door to puncture (DTP) time, and stroke treatment volumes were evaluated for sex differences. Results 1,156 cases were analyzed, 638 (55%) were female. EMS FAST-ED compliance decreased by 17%, but did not differ by sex or ethnicity. EMS FAST-ED score was similar for females and males. Despite the similarity in FAST-ED score, females scored higher on the initial NIHSS ( F(1) = 6.25, p &lt; .05) and discharge NIHSS ( F(1) = 8.588, p &lt; .01). Those diagnosed with a stroke were 1.4 times more likely to be female (χ²wald = 6.21, p &lt; .01, 95% CI [1.07–1.80]). Treatment rates did not vary between sex or ethnicity and overall DTN decreased by 10 minutes (2017 cohort M = 36 minutes, SE = 1.96; 2019 cohort M = 26 minutes, SE = 1.69). Conclusions The FAST-ED demonstrated equitable implementation and scoring among a diverse population, regardless of sex or ethnicity. Additionally, patients were equally likely to receive treatment, while benefiting from a decrease in DTN times.

Addressing Disparities in Acute Stroke Management and Prognosis.

There are now abundant data demonstrating disparities in acute stroke management and prognosis; however, interventions to reduce these disparities remain limited. This special report aims to provide a critical review of the current landscape of disparities in acute stroke care and highlight opportunities to use implementation science to reduce disparities throughout the early care continuum. In the prehospital setting, stroke symptom recognition campaigns that have been successful in reducing prehospital delays used a multilevel approach to education, including mass media, culturally tailored community education, and professional education. The mobile stroke unit is an organizational intervention that has the potential to provide more equitable access to timely thrombolysis and thrombectomy treatments. In the hospital setting, interventions to address implicit biases among health care providers in acute stroke care decision-making are urgently needed as part of a multifaceted approach to advance stroke equity. Implementing stroke systems of care interventions, such as evidence-based stroke care protocols at designated stroke centers, can have a broader public health impact and may help reduce geographic, racial, and ethnic disparities in stroke care, although further research is needed. The long-term impact of disparities in acute stroke care cannot be underestimated. The consistent trend of longer time to treatment for Black and Hispanic people experiencing stroke has direct implications on long-term disability and independence after stroke. A learning health system model may help expedite the translation of evidence-based interventions into clinical practice to reduce disparities in stroke care.