Abstract Details

Title Predictors of ED Presentation Times in Stroke Code Patients

Topic Health Care Disparities

Presentation(s) S28 - Health Care Disparities (1:48 PM-2:00 PM)

Poster/Presentation
Number 005

Background Many stroke patients present in a delayed manner, reducing eligibility for acute treatments.

Objective We aimed to evaluate sociodemographic characteristics of geographic regions from which ischemic stroke patients present that may be associated with delays in ED arrival.

Design/Methods We studied residential zip-code level characteristics of patients who presented to Yale New Haven Hospital as a stroke code between 2018-2020 and were logged within our institutional stroke registry. The primary outcome was the median time from last known well to ED arrival time per residential zip code. Zip codes were excluded if contributed to less than 0.5% of stroke code volume. Zip-code level data were obtained from the 2019 American Community Survey 5-Year estimates from the U.S. Census Bureau. These zip-code level covariates included median household income, median age, and distributions of race and ethnicity.

Results

Thirty zip codes were included, representing 3,254 patients and 82% of all stroke code volume. Median time to presentation of a zip code was significantly associated with zip code median household income. For every $10,000 increase in median household income, there was an 8.8 minute decrement in median time to presentation (p-value=0.04). Every 10% increase in median percentage of White individuals in a zip code was associated with a -16.3 minute reduction in median time to presentation (p-value=.01). Higher median times were observed in zip code regions with a higher proportion of Hispanic individuals [slope 21.5 minutes for every 10 % Hispanic, p-value=0.049]. Finally, median presentation time was inversely related to the median age of patients [slope (-6.5 min/year), p-value= 0.02].

Conclusions

Geographies with younger patients, lower household income, lower proportions of White race, and greater proportion of Hispanic ethnicity were associated with longer presentation times to the ED. This zip-code level data may inform targeting of stroke community education and resources to specific locations.

Authors/Disclosures
Razaz Mageid, MD (Lahey Hospital and Medical Center) PRESENTER	Ms. Mageid has nothing to disclose.
Richa Sharma, MD (Massachusetts General Hospital, Brigham, Harvard)	Dr. Sharma has received research support from NIH. Dr. Sharma has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
Rita Okumu, MD (Yale New Haven Hospital)	Dr. Okumu has nothing to disclose.
	No disclosure on file
Adam S. Jasne, MD (Yale)	Dr. Jasne has nothing to disclose.
Rachel Forman, MD (Yale Neurology)	Dr. Forman has nothing to disclose.