Gender and Time to Arrival among Ischemic Stroke Patients in the Greater Cincinnati/Northern Kentucky Stroke Study

Tracy E. Madsen, Heidi Sucharew, Brian Katz, Kathleen A. Alwell, Charles J. Moomaw, Brett M. Kissela, Matthew L. Flaherty, Daniel Woo, Pooja Khatri, Simona Ferioli, Jason Mackey, Sharyl Martini, Felipe De Los Rios La Rosa, Dawn Kleindorfer

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Some studies of stroke patients report longer prehospital delays in women, but others conflict; studies vary in their inclusion of factors including age and stroke severity. We aimed to investigate the relationship between gender and time to emergency department (ED) arrival and the influence of age and stroke severity on this relationship. Methods Ischemic stroke patients 20 years old or older who presented to 15 hospitals within a 5-county region of Greater Cincinnati/Northern Kentucky during 2010 were included. Time from symptom onset to ED arrival and covariates were abstracted by study nurses and reviewed by study physicians. Data were analyzed using logistic regression with time to arrival dichotomized at 3 hours or less in the overall sample and then stratified by National Institutes of Health Stroke Scale (NIHSS) and age. Results 1991 strokes (55% women) were included. Time to arrival was slightly longer in women (geometric mean 337 minutes [95% confidence interval {CI} 307-369] versus 297 [95% CI 268-329], P = .05), and 24% of women versus 27% of men arrived within 3 hours (P = .15). After adjusting for age, race, NIHSS, living situation, and other covariates, gender was not associated with delayed time to arrival (OR = 1.00, 95% CI.78-1.28). This did not change across age or NIHSS categories. Conclusions After adjusting for factors including age, NIHSS score, and living alone, women and men with ischemic stroke had similar times to arrival. Arrival time is not likely a major contributor to differences in outcome between men and women.

Original languageEnglish (US)
Pages (from-to)504-510
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume25
Issue number3
DOIs
StatePublished - Mar 1 2016

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Stroke
National Institutes of Health (U.S.)
Age Factors
Hospital Emergency Service
Confidence Intervals
Logistic Models
Nurses
Physicians

Keywords

  • acute stroke
  • delay
  • Gender
  • ischemic
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine

Cite this

Gender and Time to Arrival among Ischemic Stroke Patients in the Greater Cincinnati/Northern Kentucky Stroke Study. / Madsen, Tracy E.; Sucharew, Heidi; Katz, Brian; Alwell, Kathleen A.; Moomaw, Charles J.; Kissela, Brett M.; Flaherty, Matthew L.; Woo, Daniel; Khatri, Pooja; Ferioli, Simona; Mackey, Jason; Martini, Sharyl; De Los Rios La Rosa, Felipe; Kleindorfer, Dawn.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 25, No. 3, 01.03.2016, p. 504-510.

Research output: Contribution to journalArticle

Madsen, TE, Sucharew, H, Katz, B, Alwell, KA, Moomaw, CJ, Kissela, BM, Flaherty, ML, Woo, D, Khatri, P, Ferioli, S, Mackey, J, Martini, S, De Los Rios La Rosa, F & Kleindorfer, D 2016, 'Gender and Time to Arrival among Ischemic Stroke Patients in the Greater Cincinnati/Northern Kentucky Stroke Study', Journal of Stroke and Cerebrovascular Diseases, vol. 25, no. 3, pp. 504-510. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.026
Madsen, Tracy E. ; Sucharew, Heidi ; Katz, Brian ; Alwell, Kathleen A. ; Moomaw, Charles J. ; Kissela, Brett M. ; Flaherty, Matthew L. ; Woo, Daniel ; Khatri, Pooja ; Ferioli, Simona ; Mackey, Jason ; Martini, Sharyl ; De Los Rios La Rosa, Felipe ; Kleindorfer, Dawn. / Gender and Time to Arrival among Ischemic Stroke Patients in the Greater Cincinnati/Northern Kentucky Stroke Study. In: Journal of Stroke and Cerebrovascular Diseases. 2016 ; Vol. 25, No. 3. pp. 504-510.
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abstract = "Background Some studies of stroke patients report longer prehospital delays in women, but others conflict; studies vary in their inclusion of factors including age and stroke severity. We aimed to investigate the relationship between gender and time to emergency department (ED) arrival and the influence of age and stroke severity on this relationship. Methods Ischemic stroke patients 20 years old or older who presented to 15 hospitals within a 5-county region of Greater Cincinnati/Northern Kentucky during 2010 were included. Time from symptom onset to ED arrival and covariates were abstracted by study nurses and reviewed by study physicians. Data were analyzed using logistic regression with time to arrival dichotomized at 3 hours or less in the overall sample and then stratified by National Institutes of Health Stroke Scale (NIHSS) and age. Results 1991 strokes (55{\%} women) were included. Time to arrival was slightly longer in women (geometric mean 337 minutes [95{\%} confidence interval {CI} 307-369] versus 297 [95{\%} CI 268-329], P = .05), and 24{\%} of women versus 27{\%} of men arrived within 3 hours (P = .15). After adjusting for age, race, NIHSS, living situation, and other covariates, gender was not associated with delayed time to arrival (OR = 1.00, 95{\%} CI.78-1.28). This did not change across age or NIHSS categories. Conclusions After adjusting for factors including age, NIHSS score, and living alone, women and men with ischemic stroke had similar times to arrival. Arrival time is not likely a major contributor to differences in outcome between men and women.",
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AU - Moomaw, Charles J.

AU - Kissela, Brett M.

AU - Flaherty, Matthew L.

AU - Woo, Daniel

AU - Khatri, Pooja

AU - Ferioli, Simona

AU - Mackey, Jason

AU - Martini, Sharyl

AU - De Los Rios La Rosa, Felipe

AU - Kleindorfer, Dawn

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N2 - Background Some studies of stroke patients report longer prehospital delays in women, but others conflict; studies vary in their inclusion of factors including age and stroke severity. We aimed to investigate the relationship between gender and time to emergency department (ED) arrival and the influence of age and stroke severity on this relationship. Methods Ischemic stroke patients 20 years old or older who presented to 15 hospitals within a 5-county region of Greater Cincinnati/Northern Kentucky during 2010 were included. Time from symptom onset to ED arrival and covariates were abstracted by study nurses and reviewed by study physicians. Data were analyzed using logistic regression with time to arrival dichotomized at 3 hours or less in the overall sample and then stratified by National Institutes of Health Stroke Scale (NIHSS) and age. Results 1991 strokes (55% women) were included. Time to arrival was slightly longer in women (geometric mean 337 minutes [95% confidence interval {CI} 307-369] versus 297 [95% CI 268-329], P = .05), and 24% of women versus 27% of men arrived within 3 hours (P = .15). After adjusting for age, race, NIHSS, living situation, and other covariates, gender was not associated with delayed time to arrival (OR = 1.00, 95% CI.78-1.28). This did not change across age or NIHSS categories. Conclusions After adjusting for factors including age, NIHSS score, and living alone, women and men with ischemic stroke had similar times to arrival. Arrival time is not likely a major contributor to differences in outcome between men and women.

AB - Background Some studies of stroke patients report longer prehospital delays in women, but others conflict; studies vary in their inclusion of factors including age and stroke severity. We aimed to investigate the relationship between gender and time to emergency department (ED) arrival and the influence of age and stroke severity on this relationship. Methods Ischemic stroke patients 20 years old or older who presented to 15 hospitals within a 5-county region of Greater Cincinnati/Northern Kentucky during 2010 were included. Time from symptom onset to ED arrival and covariates were abstracted by study nurses and reviewed by study physicians. Data were analyzed using logistic regression with time to arrival dichotomized at 3 hours or less in the overall sample and then stratified by National Institutes of Health Stroke Scale (NIHSS) and age. Results 1991 strokes (55% women) were included. Time to arrival was slightly longer in women (geometric mean 337 minutes [95% confidence interval {CI} 307-369] versus 297 [95% CI 268-329], P = .05), and 24% of women versus 27% of men arrived within 3 hours (P = .15). After adjusting for age, race, NIHSS, living situation, and other covariates, gender was not associated with delayed time to arrival (OR = 1.00, 95% CI.78-1.28). This did not change across age or NIHSS categories. Conclusions After adjusting for factors including age, NIHSS score, and living alone, women and men with ischemic stroke had similar times to arrival. Arrival time is not likely a major contributor to differences in outcome between men and women.

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