Lack of Racial, Ethnic, and Sex Disparities in Ischemic Stroke Care Metrics within a Tele-Stroke Network

Reddy, Sujan; Wu, Tzu Ching; Zhang, Jing; Rahbar, Mohammad Hossein; Ankrom, Christy; Zha, Alicia; Cossey, TC; Aertker, Benjamin M.; Vahidy, Farhaan S; Parsha, Kaushik; Jones, Erica; Sharrief, Anjail; Savitz, Sean I; Jagolino‐Cole, Amanda

doi:10.1016/j.jstrokecerebrovasdis.2020.105418

Cited by 18 publications

(23 citation statements)

References 23 publications

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“…While numerous prehospital LAO stroke triage algorithms have been published ( 10 ), we have found no publications on sex differences in this setting. Our results are consistent with a study of stroke triage in an urban, academic Emergency Department, and a study evaluating sex differences in a hub-and-spoke hospital telemedicine system ( 11 , 12 ). Meanwhile, a study in the two US counties in 2005-07 showed somewhat lower sensitivity for prehospital stroke recognition in women ( 13 ).…”

Section: Discussionsupporting

confidence: 90%

Sex Equitable Prehospital Stroke Triage Using Symptom Severity and Teleconsultation

et al. 2021

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Objectives: We aimed to determine whether there are sex differences in prehospital accuracy of the Stockholm Stroke Triage System (SSTS) to predict large artery occlusion (LAO) stroke, and endovascular thrombectomy (EVT), and whether clinical characteristics differ between men and women undergoing “code stroke” ambulance transport.Materials and Methods: This prospective observational study collected data between October 2017 and October 2018. We included 2,905 patients, transported as “code stroke,” by nurse-staffed ground ambulance, to a Stockholm Region hospital. Exclusion criteria were private or helicopter transport, onset outside Stockholm, and in-hospital stroke. We compared overall accuracy, sensitivity, specificity, positive and negative predictive values, and clinical characteristics between sexes.Results: No significant sex differences in SSTS predictive performance for LAO or EVT were found, overall accuracy for LAO 87.3% in women vs. 86.7% in men. Women were median 4 years older and more frequently had stroke mimics (46.2 vs. 41.8%). Women more commonly had decreased level of consciousness (14.0 vs. 10.2%) and moderate-to-severe motor symptoms (by 2.7–3.8 percentage points), and less commonly limb ataxia (7.2 vs. 9.7%).Conclusions: The SSTS had equal predictive performance for LAO and EVT among men and women, despite minor sex differences in the clinical characteristics in patients undergoing ambulance transport for suspected stroke.

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Section: Discussionsupporting

confidence: 90%

Sex Equitable Prehospital Stroke Triage Using Symptom Severity and Teleconsultation

et al. 2021

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“…The authors hypothesized that standardized stroke protocols in telestroke could contribute to more frequent utilization of guideline-based stroke therapies-which bodes well for some alleviation of these disparities. 56 With the implementation of the Furthering Access to Stroke Telemedicine Act and the expansion of telestroke networks in both rural and urban regions, further studies will be needed to fully evaluate the impact of telestroke on access and quality of care for all. 53 Such studies will be especially important given the ongoing failures in equity that are fundamentally driven by structural barriers, like systemic racism.…”

Section: Acute Carementioning

confidence: 99%

“…The authors hypothesized that standardized stroke protocols in telestroke could contribute to more frequent utilization of guideline-based stroke therapies—which bodes well for some alleviation of these disparities. 56…”

Section: Acute Carementioning

confidence: 99%

Moving Towards Equity With Digital Health Innovations for Stroke Care

Verma¹,

Towfighi

Brown³

et al. 2022

Stroke

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Digital health has long been championed as a means to expanding access to health care. Now that the COVID-19 pandemic accelerated many health systems’ integration of digital tools for care, digital health may provide a path towards more accessible stroke prevention and treatment, particularly for historically disadvantaged patient populations. Stroke management is composed of multiple time points where digital health innovations have the potential to augment health access and treatment: from primary prevention, to the time-sensitive detection of ischemic stroke, administration of thrombolytic agents and consideration for endovascular interventions, to appropriate post-acute care, rehabilitation, and lifelong secondary stroke prevention—stroke care relies on a multidisciplinary and standardized approach. However, as we discuss pointedly in this Focused Update, underrepresented individuals face multilevel digital health disparities that potentially diminish the benefits of these digital advances. As such, these multilevel needs must be discussed and accounted for as health systems seek to integrate innovative and equitable digital health solutions towards stroke care.

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“…Prior studies have shown that tele-stroke programs improve the timeliness of thrombolysis treatments ( Lee et al, 2017 ). In addition, tele-stroke services may reduce the racial, ethnic, and sex disparities in ischemic stroke care ( Reddy et al, 2021 ). Furthermore, current human prediction accuracy of LVO patient outcome requires improvement, as evidenced by the current rate of poor prognosis after successful ET (futile reperfusion, observed in 50% of LVO patients undergoing ET) ( Meinel et al, 2020 ) and the high percentage (92–93%) of LVO patients who do not currently meet criteria for ET ( Desai et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

CT angiographic radiomics signature for risk stratification in anterior large vessel occlusion stroke

Avery

Behland²,

Mak³

et al. 2022

NeuroImage: Clinical

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Lack of Racial, Ethnic, and Sex Disparities in Ischemic Stroke Care Metrics within a Tele-Stroke Network

Cited by 18 publications

References 23 publications

Sex Equitable Prehospital Stroke Triage Using Symptom Severity and Teleconsultation

Sex Equitable Prehospital Stroke Triage Using Symptom Severity and Teleconsultation

Moving Towards Equity With Digital Health Innovations for Stroke Care

CT angiographic radiomics signature for risk stratification in anterior large vessel occlusion stroke

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