Socioeconomic disparities in prehospital stroke care.
Education
Income
Prehospital delay
Stroke
Transient ischaemic attack
Journal
Scandinavian journal of trauma, resuscitation and emergency medicine
ISSN: 1757-7241
Titre abrégé: Scand J Trauma Resusc Emerg Med
Pays: England
ID NLM: 101477511
Informations de publication
Date de publication:
02 May 2019
02 May 2019
Historique:
received:
17
02
2019
accepted:
17
04
2019
entrez:
4
5
2019
pubmed:
3
5
2019
medline:
14
6
2019
Statut:
epublish
Résumé
Recent studies have revealed socioeconomic disparities in stroke outcomes. Here, we investigated whether prehospital stroke care differs with respect to socioeconomic status (SES). Consecutive stroke and TIA patients (n = 3006) admitted to stroke units at Sahlgrenska University Hospital, Gothenburg, Sweden, from 1 November 2014 to 31 July 2016, were included. Data on prehospital care were obtained from a local stroke register. Socioeconomic status was classified according to the average level of income and education within each patient's neighbourhood (postcode area). The median system delay from calling the emergency medical communication centre (EMCC) to start of brain computed tomography on hospital arrival was 3 h 47 min (95% confidence interval (CI) 3 h 30 min to 4 h 05 min) for patients within the lowest SES tertile and 3 h 17 min (95% CI 3 h 00 min to 3 h 37 min) for the highest tertile (p < 0.05). Patients with a lower SES were less likely to receive the highest priority in the ambulance (p < 0.05) and had lower rates of prehospital recognition of stroke/TIA (p < 0.05) than those with a high SES. No inequities were found concerning EMCC prioritisation or the probability of ambulance transport. We found socioeconomic inequities in prehospital stroke care which could affect the efficacy of acute stroke treatment. The ambulance nurses' ability to recognise stroke/TIA may partly explain the observed inequities.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Recent studies have revealed socioeconomic disparities in stroke outcomes. Here, we investigated whether prehospital stroke care differs with respect to socioeconomic status (SES).
METHODS
METHODS
Consecutive stroke and TIA patients (n = 3006) admitted to stroke units at Sahlgrenska University Hospital, Gothenburg, Sweden, from 1 November 2014 to 31 July 2016, were included. Data on prehospital care were obtained from a local stroke register. Socioeconomic status was classified according to the average level of income and education within each patient's neighbourhood (postcode area).
RESULTS
RESULTS
The median system delay from calling the emergency medical communication centre (EMCC) to start of brain computed tomography on hospital arrival was 3 h 47 min (95% confidence interval (CI) 3 h 30 min to 4 h 05 min) for patients within the lowest SES tertile and 3 h 17 min (95% CI 3 h 00 min to 3 h 37 min) for the highest tertile (p < 0.05). Patients with a lower SES were less likely to receive the highest priority in the ambulance (p < 0.05) and had lower rates of prehospital recognition of stroke/TIA (p < 0.05) than those with a high SES. No inequities were found concerning EMCC prioritisation or the probability of ambulance transport.
CONCLUSIONS
CONCLUSIONS
We found socioeconomic inequities in prehospital stroke care which could affect the efficacy of acute stroke treatment. The ambulance nurses' ability to recognise stroke/TIA may partly explain the observed inequities.
Identifiants
pubmed: 31046804
doi: 10.1186/s13049-019-0630-6
pii: 10.1186/s13049-019-0630-6
pmc: PMC6498576
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
53Subventions
Organisme : Västra Götalandsregionen
ID : N/A
Organisme : Stroke Centre West
ID : N/A
Organisme : Rune och Ulla Amlövs Stiftelse för Neurologisk och Reumatologisk Forskning
ID : N/A
Organisme : John och Brit Wennerströms Stiftelse för Neurologisk Forskning
ID : N/A
Organisme : Insamlingsstiftelsen för neurologisk forskning
ID : N/A
Organisme : Peter Eriksson's Foundation
ID : N/A
Organisme : Stiftelsen Erik and Lily Philipsons Minnesfond
ID : N/A
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