Ethnic disparities trump other risk factors in determining delay to emergency department arrival in acute ischemic stroke

Abstract

Objectives: Historically, Blacks receive treatment for acute ischemic stroke (AIS) less frequently than Whites, even after considering contraindications to treatment and socioeconomic status. Blacks also experience a longer delay between symptom onset and Emergency Department (ED) arrival for unclear reasons. The purpose of our study was to determine if these disparities exist within our biracial patient population and why.

Methods: All patients who presented to our center with AIS between July, 2008 and December 2010 were identified from a prospective registry. The relationship between patient demographics and delay to ED arrival was investigated, excluding patients with unknown time of last seen normal (LSN), race other than Black or White, in-hospital strokes, and patients who bypassed the ED.

Results: Of the 596 patients screened, 368 met inclusion criteria (median age 65 years, 39.8% female, 67.8% Black). Blacks were more likely to have a longer delay from LSN to ED arrival compared to Whites (median delay of 339 min vs 151 min, P = .0028). Black race remained an independent predictor for delayed ED arrival even after adjusting for age, sex, stroke severity, and home medication use. The same proportion of Whites and Blacks who presented within the 3-hour window received thrombolytic treatment (P = .9763).

Conclusion: Black race appeared to be the driving force in a multivariate analysis evaluating predictors of ED arrival >3 hours after LSN. Despite the increased delay to ED arrival Blacks were just as likely to receive IV tPA as Whites. Improving stroke awareness and symptom recognition may reduce delays in seeking hospitalization.