Sex differences in acute telestroke care: more to the story
BackgroundPrevious studies have shown sex differences in stroke care. Female patients have both lower thrombolytic treatment rates with OR reported as low as 0.57 and worse outcomes. With updated standards of care and improved access to care through telestroke, there is potential to reduce or allevi...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1203502/full |
| _version_ | 1797798507534352384 |
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| author | Theresa Sevilis Amanda Avila Mark McDonald Mariecken Fowler Renata Chalfin Murtaza Amir Gregory Heath Mohammed Zaman Lorianne Avino Caitlyn Boyd Lan Gao Thomas Devlin Thomas Devlin |
| author_facet | Theresa Sevilis Amanda Avila Mark McDonald Mariecken Fowler Renata Chalfin Murtaza Amir Gregory Heath Mohammed Zaman Lorianne Avino Caitlyn Boyd Lan Gao Thomas Devlin Thomas Devlin |
| author_sort | Theresa Sevilis |
| collection | DOAJ |
| description | BackgroundPrevious studies have shown sex differences in stroke care. Female patients have both lower thrombolytic treatment rates with OR reported as low as 0.57 and worse outcomes. With updated standards of care and improved access to care through telestroke, there is potential to reduce or alleviate these disparities.MethodsAcute stroke consultations seen by TeleSpecialists, LLC physicians in the emergency department in 203 facilities (23 states) from January 1, 2021 to April 30, 2021 were extracted from the Telecare by TeleSpecialists™ database. The encounters were reviewed for demographics, stroke time metrics, thrombolytics candidate, premorbid modified Rankin Score, NIHSS score, stroke risk factors, antithrombotic use, admitting diagnosis of suspected stroke, and reason not treated with thrombolytic. The treatment rates, door to needle (DTN) times, stroke metric times, and variables of treatment were compared for females and males.ResultsThere were 18,783 (10,073 female and 8,710 male) total patients included. Of the total, 6.9% of females received thrombolytics compared to 7.9% of males (OR 0.86, 95% CI 0.75–0.97, p = 0.006). Median DTN times were shorter for males than females (38 vs. 41 min, p < 0.001). Male patients were more likely to have an admitting diagnosis of suspected stroke, p < 0.001. Analysis by age showed the only decade with significant difference in thrombolytics treatment rate was 50–59 with increased treatment of males, p = 0.047. When multivariant logistic regression analysis was performed with stroke risk factors, NIHSS score, age, and admitting diagnosis of suspected stroke, the adjusted odds ratio for females was 0.9 (95% CI 0.8, 1.01), p = 0.064.ConclusionWhile treatment differences between sexes existed in the data and were apparent in univariate analysis, no significant difference was seen in multivariate analysis once stroke risk factors, age, NIHSS score and admitting diagnosis were taken into consideration in the telestroke setting. Differences in rates of thrombolysis between sexes may therefore be reflective of differences in risk factors and symptomatology rather than a healthcare disparity. |
| first_indexed | 2024-03-13T04:05:50Z |
| format | Article |
| id | doaj.art-f42b89fb653c4f1ba7a83de0fbb3c8aa |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-13T04:05:50Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-f42b89fb653c4f1ba7a83de0fbb3c8aa2023-06-21T08:12:24ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-06-011410.3389/fneur.2023.12035021203502Sex differences in acute telestroke care: more to the storyTheresa Sevilis0Amanda Avila1Mark McDonald2Mariecken Fowler3Renata Chalfin4Murtaza Amir5Gregory Heath6Mohammed Zaman7Lorianne Avino8Caitlyn Boyd9Lan Gao10Thomas Devlin11Thomas Devlin12TeleSpecialists, LLC, Fort Myers, FL, United StatesTeleSpecialists, LLC, Fort Myers, FL, United StatesTeleSpecialists, LLC, Fort Myers, FL, United StatesTeleSpecialists, LLC, Fort Myers, FL, United StatesTeleSpecialists, LLC, Fort Myers, FL, United StatesTeleSpecialists, LLC, Fort Myers, FL, United StatesPublic Health, University of Tennessee at Chattanooga, Chattanooga, TN, United StatesTeleSpecialists, LLC, Fort Myers, FL, United StatesTeleSpecialists, LLC, Fort Myers, FL, United StatesTeleSpecialists, LLC, Fort Myers, FL, United StatesMathematics, University of Tennessee at Chattanooga, Chattanooga, TN, United StatesTeleSpecialists, LLC, Fort Myers, FL, United StatesNeurology Department, University of Tennessee Health Science Center, Memphis, TN, United StatesBackgroundPrevious studies have shown sex differences in stroke care. Female patients have both lower thrombolytic treatment rates with OR reported as low as 0.57 and worse outcomes. With updated standards of care and improved access to care through telestroke, there is potential to reduce or alleviate these disparities.MethodsAcute stroke consultations seen by TeleSpecialists, LLC physicians in the emergency department in 203 facilities (23 states) from January 1, 2021 to April 30, 2021 were extracted from the Telecare by TeleSpecialists™ database. The encounters were reviewed for demographics, stroke time metrics, thrombolytics candidate, premorbid modified Rankin Score, NIHSS score, stroke risk factors, antithrombotic use, admitting diagnosis of suspected stroke, and reason not treated with thrombolytic. The treatment rates, door to needle (DTN) times, stroke metric times, and variables of treatment were compared for females and males.ResultsThere were 18,783 (10,073 female and 8,710 male) total patients included. Of the total, 6.9% of females received thrombolytics compared to 7.9% of males (OR 0.86, 95% CI 0.75–0.97, p = 0.006). Median DTN times were shorter for males than females (38 vs. 41 min, p < 0.001). Male patients were more likely to have an admitting diagnosis of suspected stroke, p < 0.001. Analysis by age showed the only decade with significant difference in thrombolytics treatment rate was 50–59 with increased treatment of males, p = 0.047. When multivariant logistic regression analysis was performed with stroke risk factors, NIHSS score, age, and admitting diagnosis of suspected stroke, the adjusted odds ratio for females was 0.9 (95% CI 0.8, 1.01), p = 0.064.ConclusionWhile treatment differences between sexes existed in the data and were apparent in univariate analysis, no significant difference was seen in multivariate analysis once stroke risk factors, age, NIHSS score and admitting diagnosis were taken into consideration in the telestroke setting. Differences in rates of thrombolysis between sexes may therefore be reflective of differences in risk factors and symptomatology rather than a healthcare disparity.https://www.frontiersin.org/articles/10.3389/fneur.2023.1203502/fulltelestrokehealthcare disparitiesstrokewomenacute stroke carethrombolytics |
| spellingShingle | Theresa Sevilis Amanda Avila Mark McDonald Mariecken Fowler Renata Chalfin Murtaza Amir Gregory Heath Mohammed Zaman Lorianne Avino Caitlyn Boyd Lan Gao Thomas Devlin Thomas Devlin Sex differences in acute telestroke care: more to the story Frontiers in Neurology telestroke healthcare disparities stroke women acute stroke care thrombolytics |
| title | Sex differences in acute telestroke care: more to the story |
| title_full | Sex differences in acute telestroke care: more to the story |
| title_fullStr | Sex differences in acute telestroke care: more to the story |
| title_full_unstemmed | Sex differences in acute telestroke care: more to the story |
| title_short | Sex differences in acute telestroke care: more to the story |
| title_sort | sex differences in acute telestroke care more to the story |
| topic | telestroke healthcare disparities stroke women acute stroke care thrombolytics |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1203502/full |
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