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Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study.
Dhand, Amar; Reeves, Mathew J; Mu, Yi; Rosner, Bernard A; Rothfeld-Wehrwein, Zachary R; Nieves, Amber; Dhongade, Vrushali A; Jarman, Molly; Bergmark, Regan W; Semco, Robert S; Ader, Jeremy; Marshall, Brandon D L; Goedel, William C; Fonarow, Gregg C; Smith, Eric E; Saver, Jeffrey L; Schwamm, Lee H; Sheth, Kevin N.
Afiliação
  • Dhand A; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).
  • Reeves MJ; Department of Neurology (A.D., Z.R.R.-W., V.A.D.), Brigham and Women's Hospital, Boston, MA.
  • Mu Y; Network Science Institute, Northeastern University, Boston, MA (A.D.).
  • Rosner BA; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.).
  • Rothfeld-Wehrwein ZR; Department of Biostatistics, Channing Laboratory, Harvard T.H. Chan School of Public Health, Boston, MA (Y.M., B.A.R.).
  • Nieves A; Department of Biostatistics, Channing Laboratory, Harvard T.H. Chan School of Public Health, Boston, MA (Y.M., B.A.R.).
  • Dhongade VA; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).
  • Jarman M; Department of Neurology (A.D., Z.R.R.-W., V.A.D.), Brigham and Women's Hospital, Boston, MA.
  • Bergmark RW; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (A.N.).
  • Semco RS; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).
  • Ader J; Department of Neurology (A.D., Z.R.R.-W., V.A.D.), Brigham and Women's Hospital, Boston, MA.
  • Marshall BDL; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).
  • Goedel WC; Department of Otolaryngology-Head and Neck Surgery (M.J., R.W.B.), Brigham and Women's Hospital, Boston, MA.
  • Fonarow GC; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).
  • Smith EE; Center for Surgery and Public Health (R.W.B., R.S.S.), Brigham and Women's Hospital, Boston, MA.
  • Saver JL; Department of Otolaryngology-Head and Neck Surgery (M.J., R.W.B.), Brigham and Women's Hospital, Boston, MA.
  • Schwamm LH; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).
  • Sheth KN; Center for Surgery and Public Health (R.W.B., R.S.S.), Brigham and Women's Hospital, Boston, MA.
Stroke ; 55(6): 1507-1516, 2024 Jun.
Article em En | MEDLINE | ID: mdl-38787926
ABSTRACT

BACKGROUND:

Delays in hospital presentation limit access to acute stroke treatments. While prior research has focused on patient-level factors, broader ecological and social determinants have not been well studied. We aimed to create a geospatial map of prehospital delay and examine the role of community-level social vulnerability.

METHODS:

We studied patients with ischemic stroke who arrived by emergency medical services in 2015 to 2017 from the American Heart Association Get With The Guidelines-Stroke registry. The primary outcome was time to hospital arrival after stroke (in minutes), beginning at last known well in most cases. Using Geographic Information System mapping, we displayed the geography of delay. We then used Cox proportional hazard models to study the relationship between community-level factors and arrival time (adjusted hazard ratios [aHR] <1.0 indicate delay). The primary exposure was the social vulnerability index (SVI), a metric of social vulnerability for every ZIP Code Tabulation Area ranging from 0.0 to 1.0.

RESULTS:

Of 750 336 patients, 149 145 met inclusion criteria. The mean age was 73 years, and 51% were female. The median time to hospital arrival was 140 minutes (Q1 60 minutes, Q3 458 minutes). The geospatial map revealed that many zones of delay overlapped with socially vulnerable areas (https//harvard-cga.maps.arcgis.com/apps/webappviewer/index.html?id=08f6e885c71b457f83cefc71013bcaa7). Cox models (aHR, 95% CI) confirmed that higher SVI, including quartiles 3 (aHR, 0.96 [95% CI, 0.93-0.98]) and 4 (aHR, 0.93 [95% CI, 0.91-0.95]), was associated with delay. Patients from SVI quartile 4 neighborhoods arrived 15.6 minutes [15-16.2] slower than patients from SVI quartile 1. Specific SVI themes associated with delay were a community's socioeconomic status (aHR, 0.80 [95% CI, 0.74-0.85]) and housing type and transportation (aHR, 0.89 [95% CI, 0.84-0.94]).

CONCLUSIONS:

This map of acute stroke presentation times shows areas with a high incidence of delay. Increased social vulnerability characterizes these areas. Such places should be systematically targeted to improve population-level stroke presentation times.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Sistema de Registros / Tempo para o Tratamento / AVC Isquêmico / Hospitalização Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Stroke Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Sistema de Registros / Tempo para o Tratamento / AVC Isquêmico / Hospitalização Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Stroke Ano de publicação: 2024 Tipo de documento: Article