Need to Prioritize Education of the Public Regarding Stroke Symptoms and Faster Activation of the 9-1-1 System: Findings from the Florida–Puerto Rico CReSD Stroke Registry

Abstract

Objective: Demographic differences (race/ethnicity/sex) in 9-1-1 emergency medical services (EMS) access and utilization have been reported for various time-dependent critical illnesses along with associated outcome disparities. However, data are lacking with respect to measuring the various components of time taken to reach definitive care facilities following the onset of acute stroke symptoms (i.e., stroke onset to 9-1-1 call, EMS response, time on-scene, transport interval) and particularly with respect to any differences across ethnicities and sex. Therefore, the specific aim of this study was to measure the various time intervals elapsing following the first symptom onset (FSO) from an acute stroke until stroke hospital arrival (SHA) and to delineate any race/ ethnic/sex-related differences among any of those measurements. Methods:The Florida-Puerto Rico Stroke Registry (FLPRSR) is an on-going, voluntary stroke registry of hospitals participating in the Get with the Guidelines-Stroke initiative. The study population included patients treated at Florida hospitals participating in the FLPRSR between 2010 and 2014 who had called 9-1-1 and were managed and transported by EMS. In total, 10,481 patients (16% black, 8% Hispanic, 74% white) had complete data-sets that included birthdate/year, sex, ethnic background, date/hour/minute of FSO and date/hour/minute of EMS response, scene arrival and SHA.

Evidence-Based Disparities in Stroke Care Metrics and Outcomes in the United States: A Systematic Review

“…After screening studies based on titles and abstracts, 56 studies were excluded. The full articles of the remaining 32 studies were reviewed, and 30 studies were included in the quantitative synthesis 14,20–48 (see the Figure for PRISMA chart [Preferred Reporting Items for Systematic Reviews and Meta-Analyses]). The characteristics and racial makeup of each included study are presented in Table S1.…”

“…In contrast, 1 study reported shorter time to treatment for Hispanic and Black patients as compared with non-Hispanic White patients. 42 One study reported similar times to treatment for Hispanic patients when compared with White patients. 21 When dichotomized, arrival rates to the health care facility within 3 hours of symptom onset are more common in White patients as compared with African American and Hispanic patients (Table 3).…”

“…42,50,51 Interestingly, a large Registry found no racial/ethnic differences in EMS response time following 9-1-1 activation. 42 However, the degree to which disparities in onset-to-treatment time and door-to-treatment time depend on mode of arrival warrants further study.…”

“…Additional factors contributing to longer arrival time include geographic distance from the hospital, the time interval between symptom onset and 9-1-1 activation, and the speed with which EMS is activated. 42,50,51 Interestingly, a large Registry found no racial/ethnic differences in EMS response time following 9-1-1 activation. 42 However, the degree to which disparities in onset-to-treatment time and door-to-treatment time depend on mode of arrival warrants further study.…”

Thrombolysis in Mexico: Current status and opportunities

“…After a decade from approval of thrombolysis for stroke treatment, only a modest decrease in pre-hospital delays of 6% per year was noted in an international study 18 . More recent reports from the State of Florida in the US have shown a persistent average delay of 301 min from symptom onset to 911 call 19 . This underlies the importance of more extensive public education on early recognition of stroke symptoms and the urgency of reaching the correct facility for appropriate acute intervention.…”