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

Helen Rynor, Kelly Nguyen, Jadthiel Oliva, Lisa Nirvanie-Persaud, Starlie C. Belnap, Felipe De Los Rios La Rosa
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Abstract

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 < .05) and discharge NIHSS ( F(1) = 8.588, p < .01). Those diagnosed with a stroke were 1.4 times more likely to be female (χ²wald = 6.21, p < .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.
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生理性别对县级院前卒中干预措施的影响
背景:与男性相比,女性受中风的影响更大。这可能归因于女性的非传统中风症状和中风护理的性别差异。本研究探讨了 FAST-ED 和脑卒中结果中的性别和种族差异。方法:2017 年建立的医院内部登记处评估了 EMS FAST-ED 合规性并监测了患者预后。我们评估了两个队列,即 FAST-ED 实施一年后收集的 2017 年队列和 FAST-ED 实施两年后收集的 2019 年队列。纳入标准包括年龄≥18 岁通过 EMS 到达的卒中警报患者;不包括步行入院的患者。对 EMS FAST-ED 合规性、FAST-ED 评分、最终诊断、门到针时间 (DTN)、门到穿刺时间 (DTP) 和卒中治疗量进行了性别差异评估。结果分析了 1,156 个病例,其中 638 例(55%)为女性。急救FAST-ED依从性下降了17%,但没有性别或种族差异。女性和男性的急救中心 FAST-ED 评分相似。尽管 FAST-ED 评分相似,但女性在初始 NIHSS ( F(1) = 6.25,p < .05) 和出院 NIHSS ( F(1) = 8.588,p < .01) 中得分更高。确诊为脑卒中的患者中,女性的可能性是男性的 1.4 倍(χ²wald = 6.21,p < .01,95% CI [1.07-1.80])。不同性别或种族的治疗率没有差异,DTN总体减少了10分钟(2017年队列M = 36分钟,SE = 1.96;2019年队列M = 26分钟,SE = 1.69)。结论:无论性别或种族如何,FAST-ED 在不同人群中的实施和评分都是公平的。此外,患者接受治疗的可能性相同,同时受益于 DTN 时间的缩短。
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