Race- and Ethnicity-Specific Hospital Arrival and Emergency Medicine Service Activation Times by US State for Ischemic Stroke.

BACKGROUND: Delayed hospital arrival after 4.5 hours of stroke onset excludes patients from intravenous thrombolytic therapy. In the United States, prehospital triage is regulated by each state. Understanding race- and ethnicity-specific prehospital delays in each state could guide targeted interventions. METHODS: This cross-sectional study examined adult patients treated at the GWTG (Get With The Guidelines)-Stroke participating hospitals from January 2021 to August 2023 for acute ischemic stroke. The outcomes, including onset-to-arrival >4.5 hours, onset-to-911 call >2.5 hours, and 911 call-to-arrival >1 hour by race and ethnicity and state, were examined using multivariable logistic regression analysis adjusting for patient and hospital-level characteristics. RESULTS: The study included 691 689 patients with a median age of 71 years and 48.6% women. Compared with White patients, risk-adjusted odds of onset-to-arrival >4.5 hours were higher in Asian patients (1.24 [95% CI, 1.20-1.28]), Black patients (1.18 [95% CI, 1.16-1.19]), and Hispanic patients (1.10 [95% CI, 1.07-1.12]); onset-to-911 call >2.5 hours was higher among Black patients (1.21 [95% CI, 1.16-1.26]); and 911 call-to-arrival >1 hour was lower among Asian (0.55 [95% CI, 0.49-0.63]), Black patients (0.67 [95% CI, 0.62-0.72]), and Hispanic patients (0.69 [95% CI, 0.63-0.75]). Relative to Texas, which has the highest racial and ethnic diversity index, the odds of onset-to-arrival >4.5 hours were higher in 20 states for non-White patients and 9 states for White patients. CONCLUSIONS: Delayed hospital arrivals are more prevalent among Asian, Black, and Hispanic patients, but emergency medicine service transportation times are shorter, suggesting the need for culturally tailored community stroke education. A few states have exceedingly high delayed arrival, highlighting an opportunity to improve state-wide stroke readiness and emergency medicine service triage.

Duke Scholars

Author Brooke Alhanti  

Author Brian C. Mac Grory Neurology, Stroke and Vascular Neurology

Author Ying Xian Neurology, Neurocritical Care