Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines-Stroke Registry.
Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines-Stroke Registry.
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DOI：
10.1161/jaha.115.002099
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发表时间：
2015-08-12
影响因子：
5.4
通讯作者：
Smith EE
中科院分区：
文献类型：
--
作者：
Mochari-Greenberger H;Xian Y;Hellkamp AS;Schulte PJ;Bhatt DL;Fonarow GC;Saver JL;Reeves MJ;Schwamm LH;Smith EE
急诊医疗服务（EMS）激活的差异可能导致卒中结局的种族/民族和性别差异。本研究的目的是确定EMS的使用是否因种族/民族和性别而异，目前，不同的国家样本的住院急性卒中患者。我们分析了2011年10月至2014年3月期间1613家参与指南-卒中参与医院收治的398 798例卒中患者的数据。多变量逻辑回归用于评估种族/民族和性别组与EMS使用的组合之间的关联，调整潜在的混杂因素，包括人口统计学，病史和卒中症状。患者中50%为女性，69%为白色，19%为黑人，8%为西班牙裔，3%为亚裔，1%为其他，86%患有缺血性卒中。总体而言，59%的中风患者是通过EMS运送到医院的。白色女性最有可能使用EMS（62%）;西班牙裔男性最不可能使用EMS（52%）。调整患者特征后，西班牙裔和亚裔男性和女性使用EMS的调整后比值比白色男性和女性低20%至29%;黑人女性使用EMS的可能性低于白色女性（比值比0.75，95% CI 0.72至0.77）。有虚弱或轻瘫、意识水平改变和/或失语症的患者比没有这些症状的患者更有可能使用EMS;在校正卒中症状后，观察到的EMS使用的种族/民族和性别差异仍然显著。EMS的使用因种族/民族和性别而异。这些当代数据记录了EMS转运在美国卒中患者中的次优使用，特别是少数种族/民族和卒中症状不太明显的患者。
Differences in activation of emergency medical services (EMS) may contribute to racial/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS use varied by race/ethnicity and sex among a current, diverse national sample of hospitalized acute stroke patients. We analyzed data from 398 798 stroke patients admitted to 1613 Get With The Guidelines–Stroke participating hospitals between October 2011 and March 2014. Multivariable logistic regression was used to evaluate the associations between combinations of racial/ethnic and sex groups with EMS use, adjusting for potential confounders including demographics, medical history, and stroke symptoms. Patients were 50% female, 69% white, 19% black, 8% Hispanic, 3% Asian, and 1% other, and 86% had ischemic stroke. Overall, 59% of stroke patients were transported to the hospital by EMS. White women were most likely to use EMS (62%); Hispanic men were least likely to use EMS (52%). After adjustment for patient characteristics, Hispanic and Asian men and women had 20% to 29% lower adjusted odds of using EMS versus their white counterparts; black women were less likely than white women to use EMS (odds ratio 0.75, 95% CI 0.72 to 0.77). Patients with weakness or paresis, altered level of consciousness, and/or aphasia were significantly more likely to use EMS than patients without each symptom; the observed racial/ethnic and sex differences in EMS use remained significant after adjustment for stroke symptoms. EMS use differed by race/ethnicity and sex. These contemporary data document suboptimal use of EMS transport among US stroke patients, especially by racial/ethnic minorities and those with less recognized stroke symptoms.