Could The “Modified 8 D’s of Stroke Care” Improve Sex Disparities in Door-to-Needle Time in Acute Ischemic Stroke?

Abstract

Background and objectiveDoor-to-needle (DTN) time is an important factor in stroke settings for which studies have reported delays in women, resulting in worse stroke outcomes. We aimed to evaluate whether our modified algorithm could reduce sex disparities, especially in DTN.MethodsThis longitudinal cohort study was conducted between September 1, 2019, and August 31, 2021, at a comprehensive stroke center. Previously we utilized the conventional “D’s of stoke care” for timely management. The “modified 8 D’s of stroke care” was designed by our team in September 2020. Patients were analyzed in two groups: group 1, before, and group 2, after employing the modified algorithm. Sex as the main variable of interest along with other selected covariates were regressed towards the DTN, using univariable and multivariable logistic regressions.ResultsWe enrolled 47 and 56 patients who received intravenous thrombolysis (IVT) in groups 1 and 2, respectively. Although there was a significant difference in DTN≤ 1 hour in group 1 (36% of females vs. 52% of males, p= 0.019), it was not significantly different in group 2 anymore (48% of females vs. 48.4% of males, p= 0.97). Furthermore, regression analysis showed being female was a significant predictor of DTN> 1 hour in group 1 (aOR= 6.65, p= 0.02), while after the modified algorithm gender was not a predictor of delayed DTN anymore.ConclusionAlthough we have a long way to achieve performance measures in developed countries, we seem to have succeeded in reducing gender disparities in DTN using the modified algorithm.