BACKGROUND Disparities in time to hospital presentation and prehospital stroke care may be important drivers in inequities in acute stroke treatment rates, functional outcomes, and mortality. It is unknown how patient-level factors, such as race and ethnicity and county-level socioeconomic status, affect these aspects of prehospital stroke care. METHODS Cross-sectional study of patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage in the Get With the Guidelines-Stroke registry, presenting from July 2015 to December 2019, with symptom onset ≤24 hours. Multivariable logistic regression and quantile regression were used to investigate the outcomes of interest: emergency medical services (EMS) transport (versus private vehicle), EMS prehospital notification (versus no prehospital notification), and stroke symptom onset to time of arrival at the emergency department. Prespecified covariates included patient-level, hospital-level, and county-level characteristics. RESULTS The inclusion criteria was met by the 606 369 patients. Of the patients, 51.2% were men and 69.9% White, with a median National Institutes of Health Stroke Severity of 4 (IQR, 2-10), and median social deprivation index (SDI) of 51 (IQR, 27-75). Median symptom onset to arrival time was 176 minutes (IQR, 64-565). Black race was significantly associated with prolonged symptom onset to emergency department arrival time (+28.21 minutes [95% CI, 25.59-30.84]), and decreased odds of EMS prehospital notification (OR, 0.80 [95% CI, 0.78-0.82]). SDI was not associated with differences in EMS use but was associated with lower odds of EMS prehospital notification (upper SDI tercile versus lowest, OR, 0.79 [95% CI, 0.78-0.81]). SDI was also significantly associated with stroke symptom onset to emergency department arrival time (upper SDI tercile versus lowest +2.56 minutes [95% CI, 0.58-4.53]). CONCLUSIONS In this national cross-sectional study, Black race was associated with prolonged symptom onset to time of arrival intervals and significantly decreased odds of EMS prehospital notification, despite similar use of EMS transport. Greater county-level deprivation was also associated with reduced odds of EMS prehospital notification and slightly prolonged stroke symptom onset to emergency department arrival time. Efforts to reduce place-based disparities in stroke care must address significant inequities in prehospital care of acute stroke and continue to address health inequities associated with race and ethnicity.

中文翻译：

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急性中风患者在紧急医疗服务使用、院前通知和症状发作到到达方面的差异。


背景 出院时间和院前卒中护理的差异可能是急性卒中治疗率、功能结局和死亡率不平等的重要驱动因素。目前尚不清楚患者层面的因素，例如种族和民族以及县级社会经济地位，如何影响院前卒中护理的这些方面。方法 2015 年 7 月至 2019 年 12 月就诊，症状发作 ≤24 小时，缺血性卒中、脑出血和蛛网膜下腔出血患者的缺血性卒中、脑出血和蛛网膜下腔出血患者的横断面研究。多变量 logistic 回归和分位数回归用于调查感兴趣的结局： 紧急医疗服务 （EMS） 运输（与私家车相比）、EMS 院前通知（与无院前通知相比）以及中风症状发作至到达急诊科的时间。预先指定的协变量包括患者水平、医院水平和县级特征。结果 606 369 例患者符合纳入标准。在这些患者中，51.2% 为男性，69.9% 为白人，美国国立卫生研究院中风严重程度中位数为 4 （IQR，2-10），社会剥夺指数 （SDI） 中位数为 51 （IQR，27-75）。中位症状发作至到达时间为 176 分钟 （IQR， 64-565）。黑人与症状发作至急诊科到达时间延长（+28.21 分钟 [95% CI，25.59-30.84]） 和 EMS 院前通知的几率降低 （OR，0.80 [95% CI，0.78-0.82]） 显著相关。SDI 与 EMS 使用的差异无关，但与 EMS 院前通知的较低几率相关 （SDI 上三级与最低，OR，0.79 [95% CI，0.78-0.81]）。 SDI 也与卒中症状发作至急诊科到达时间显著相关 （SDI 上三级与最低 +2.56 分钟 [95% CI，0.58-4.53]）。结论 在这项全国横断面研究中，尽管类似地使用 EMS 运输，但黑人种族与症状发作到到达间隔时间延长有关，并且 EMS 院前通知的几率显着降低。更大的县级剥夺也与 EMS 院前通知的几率降低和中风症状发作至急诊科到达时间的略微延长有关。减少中风护理中基于地点的差异的努力必须解决急性中风院前护理中的重大不平等问题，并继续解决与种族和民族相关的健康不平等问题。